NPIMap

Organization Active NPI

Changing Lives Adult & Youth Services

  • Community/Behavioral Health Agency
  • Clinton, MD
National Provider Identifier
1609320340
Registry record updated Sep 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
1771 Issued in MD
Legal business name
CHANGING LIVES ADULT & YOUTH SERVICES
Practice address
9015 Woodyard Rd Ste 109
Clinton, MD 20735-4226
Phone
(240) 244-2924
Fax
(240) 244-5225
NPI assigned
Aug 11, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Sydney Baskins
Title
Ceo
Phone
(301) 541-0963

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 1771 MD
Community/Behavioral Health Agency 251S00000X 1771 MD Primary

Addresses

Primary practice location

9015 Woodyard Rd Ste 109
Clinton, MD 20735-4226

Mailing address

9015 Woodyard Rd Ste 109
Clinton, MD 20735-4226
Phone (240) 244-2924

Other identifiers 2

IdentifierTypeStateIssuer
1902241250MedicaidMD
1609320340MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Changing Lives Adult Youth Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9015 Woodyard Rd
Ste 109
Clinton, MD 20735
Phone (240) 244-2924

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568073600000",
    "number": "1609320340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9015 WOODYARD RD STE 109",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207354226",
            "telephone_number": "240-244-2924",
            "fax_number": "240-244-5225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9015 WOODYARD RD STE 109",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207354226",
            "telephone_number": "240-244-2924",
            "fax_number": "240-244-5225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGING LIVES ADULT & YOUTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-11",
        "last_updated": "2019-09-10",
        "status": "A",
        "authorized_official_last_name": "BASKINS",
        "authorized_official_first_name": "SYDNEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-541-0963",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "MD",
            "license": "1771",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MD",
            "license": "1771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902241250",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609320340",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.