PLACE FOR CHANGE (NPI# 1477917979) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477917979 |
| Entity Type | Organization |
| Organization Name | PLACE FOR CHANGE |
| Practice Address |
117 Maple Ridge Rd Reisterstown MD 21136-6518 |
| Practice Telephone | 4103708544 |
| Mailing Telephone | 4103708544 |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2016-04-11 |
| Authorized Official Name | THERESA THOMAS (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 4103708544 |
| Authorized Official Credential | ASA-AD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Street Address |
117 MAPLE RIDGE RD |
| City | REISTERSTOWN |
| State | MD |
| Zip Code | 21136-6518 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336791276 | Iyawamiwa Shittu | Counselor | 11 Chartley Drive, Reisterstown, MD 21136 | 2019-07-11 |
| 1508334517 | Amanda Britton | Speech-Language Pathologist | 12039 Reisterstown Rd., Reisterstown, MD 21136 | 2018-11-07 |
| 1366964272 | Marc Manko | Physician Assistant | 12608 Mt. Laurel Ct., Reisterstown, MD 21136 | 2017-07-12 |
| 1518325794 | Diana Jebaraj | Occupational Therapist | 15 Sunday Ct, Reisterstown, MD 21136 | 2016-02-03 |
| 1164816823 | Golda-amit Incorporated | Supports Brokerage | 11919 Tarragon Rd, Apt A, Reisterstown, MD 21136 | 2015-03-20 |
| 1073925210 | Irina Koyfman | Nurse Practitioner | 321 Chamborley Drive, Reisterstown, MD 21136 | 2014-05-22 |
| 1033462627 | Tracy Brenton | Counselor | 14450 Hanover Pike, Reisterstown, MD 21136 | 2012-10-19 |
| 1760738884 | Bonnie Lynne Haines | Massage Therapist | 141 Westminster Pike, Reisterstown, MD 21136 | 2012-07-26 |
| 1588921464 | Alexsandr Fishman | Dentist | 11710 Reisterstown Rd Ste 201, Reisterstown, MD 21136 | 2012-04-18 |
| 1992000954 | Darlene L. Reaka Israel | Nurse Practitioner | 23 Chartley Park Rd, Reisterstown, MD 21136 | 2011-01-21 |
| Find all providers in zip 21136 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477151066 | Evolve Residential, LLC | Substance Abuse Rehabilitation Facility | 486 Lincoln Dr, Glen Burnie, MD 21060-8706 | 2020-10-15 |
| 1841898434 | Evolve Residential, LLC | Substance Abuse Rehabilitation Facility | 394 Washington Ave, Glen Burnie, MD 21060-8712 | 2020-10-15 |
| 1942808050 | Powell Recovery Center, Inc. | Substance Abuse Rehabilitation Facility | 10 S Broadway, Baltimore, MD 21231-1775 | 2020-10-12 |
| 1396343414 | Powell Recovery Center, Inc. | Substance Abuse Rehabilitation Facility | 15 S Broadway, Baltimore, MD 21231-1714 | 2020-10-12 |
| 1801494984 | Evolve Residential, LLC | Substance Abuse Rehabilitation Facility | 8315 Veterans Hwy, Millersville, MD 21108-1421 | 2020-10-12 |
| 1124626296 | Evolve Residential, LLC | Substance Abuse Rehabilitation Facility | 390 Washington Ave, Glen Burnie, MD 21060-8712 | 2020-10-12 |
| 1457968984 | Powell Recovery Center | Substance Abuse Rehabilitation Facility | 22 S Broadway, Baltimore, MD 21231-1711 | 2020-09-29 |
| 1356956676 | The Elysian Fields Optimum Wellness and Mental Health Group, LLC | Substance Abuse Rehabilitation Facility | 2901 Erdman Ave, Baltimore, MD 21213-1139 | 2020-09-14 |
| 1134731284 | Serenity Keepers of Maryland LLC | Substance Abuse Rehabilitation Facility | 3645 Cottage Ave, Baltimore, MD 21215-7725 | 2020-08-20 |
| 1255949392 | Champ House Recovery Inc. | Substance Abuse Rehabilitation Facility | 8655 Normal School Rd, Bowie, MD 20715-3326 | 2020-07-15 |
| Find all providers with the same taxonomy | ||||
| City | REISTERSTOWN |
| Zip Code | 21136 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.