Provider Demographics
NPI:1679078034
Name:CENTER FOR SOCIAL CHANGE INC
Entity type:Organization
Organization Name:CENTER FOR SOCIAL CHANGE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR OF PROGRAMS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-271-9541
Mailing Address - Street 1:6600 AMBERTON DR
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6216
Mailing Address - Country:US
Mailing Address - Phone:443-271-9541
Mailing Address - Fax:
Practice Address - Street 1:7204 BARLOW CT
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-1827
Practice Address - Country:US
Practice Address - Phone:443-271-9541
Practice Address - Fax:410-796-1201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR SOCIAL CHANGE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03AL1191-A310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility