Active NPI
Changing Lives Adult & Youth Services
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Temple Hills, MD
National Provider Identifier
1902241250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Legal business name
- CHANGING LIVES ADULT & YOUTH SERVICES
- Practice address
- 4810 Saint Barnabas Rd Ste 203
Temple Hills, MD 20748-4604 - Phone
- (202) 431-5576
- NPI assigned
- Apr 30, 2013
- Last updated
- Sep 10, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Sydney Baskins, B.A.
- Title
- Ceo
- Phone
- (301) 541-0963
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | NU | ||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | NU | Primary | |
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X | NU | ||
| Rehabilitation Clinic/Center | 261QR0400X | NU | ||
| Community/Behavioral Health Agency | 251S00000X | NU |
Addresses
Primary practice location
4810 Saint Barnabas Rd Ste 203
Temple Hills, MD 20748-4604
Mailing address
4810 Saint Barnabas Rd Ste 203
Temple Hills, MD 20748-4604
Phone (301) 541-0963
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902241250 | Medicaid | MD | |
| 1609320340 | Medicaid | MD |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | sbaskins@clayshc.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- Changing Lives Adult Youth Services
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Clinton, MD
- NPI 1609320340
Practitioners & affiliated clinicians
Practitioners 12
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Psychiatric/Mental Health Nurse Practitioner
- Takoma Park, MD
- NPI 1134554769
DC
-
- Psychiatric/Mental Health Nurse Practitioner
- Bowie, MD
- NPI 1629828710
DC
-
- Clinical Social Worker
- Washington, DC
- NPI 1285258939
-
- Clinical Social Worker
- Washington, DC
- NPI 1114596202
-
- Clinical Social Worker
- Clinton, MD
- NPI 1780146217
-
- Mental Health Occupational Therapist
- Rockville, MD
- NPI 1669212452
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367280000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1568073600000",
"number": "1902241250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4810 SAINT BARNABAS RD STE 203",
"city": "TEMPLE HILLS",
"state": "MD",
"postal_code": "207484604",
"telephone_number": "301-541-0963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4810 SAINT BARNABAS RD STE 203",
"city": "TEMPLE HILLS",
"state": "MD",
"postal_code": "207484604",
"telephone_number": "202-431-5576"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CHANGING LIVES ADULT & YOUTH SERVICES",
"organizational_subpart": "NO",
"enumeration_date": "2013-04-30",
"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.",
"authorized_official_credential": "B.A."
},
"taxonomies": [
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "261QM0855X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adolescent and Children Mental Health",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QR0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1902241250",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1609320340",
"state": "MD"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "sbaskins@clayshc.com",
"affiliation": "N",
"address_1": "4810 Saint Barnabas Rd Ste 203",
"city": "Temple Hills",
"state": "MD",
"country_code": "US",
"postal_code": "207484604",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Temple Hills, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.