Healthcare Provider Details

I. General information

NPI: 1164923439
Provider Name (Legal Business Name): CHANGING TURN COMMUNITY HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 HAMILTON AVE
BALTIMORE MD
21214-2634
US

IV. Provider business mailing address

5438 YORK RD STE 103
BALTIMORE MD
21212-3849
US

V. Phone/Fax

Practice location:
  • Phone: 443-708-1461
  • Fax:
Mailing address:
  • Phone: 443-708-1461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberBH000296
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberBH000296
License Number StateMD

VIII. Authorized Official

Name: CHAUNNA THOMAS
Title or Position: OWNER
Credential: LCPC
Phone: 443-402-0172