MEDICARE: NO ONE LEFT BEHIND CHANGING LIVES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1568174951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NO ONE LEFT BEHIND CHANGING LIVES

Provider Business Mailing Address
First Line	:	5418 YORK RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21212-3831
Country	:	US
Telephone Number	:	443-653-2489
Fax Number	:

Provider Business Practice Location Address
First Line	:	5418 YORK RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21212-3831
Country	:	US
Telephone Number	:	443-653-2489
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SEAN ALLEN
Credential	:
Telephone Number	:	443-653-2489

Provider Enumeration Date	:	12/19/2022
Last Update Date	:	12/19/2022

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