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General NPI Number Information
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NPI Number | 1205331477
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Entity Type | Organization
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Legal Business Name | CENTER FOR SOCIAL CHANGE INC
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 8419 ALLENSWOOD RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-4638
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Country | US
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Telephone | 443-271-9541
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 AMBERTON DR
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City | ELKRIDGE
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State | MD
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Zip | 21075-6216
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Country | US
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Telephone | 443-271-9541
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE DIRECTOR PROGRAMS
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Name | MRS. CAITLIN JOHNSEN
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Credential |
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Telephone | 443-271-9541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 03AL1190-A
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License Number State | MD
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