1407431901 NPI number — BUILDING LIVES ON COMMUNITY KINDNESS & STEWARDSHIP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407431901 NPI number — BUILDING LIVES ON COMMUNITY KINDNESS & STEWARDSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUILDING LIVES ON COMMUNITY KINDNESS & STEWARDSHIP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407431901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3706 GREENMOUNT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21218-1843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
141-036-6305
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3706 GREENMOUNT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-1843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-262-4822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2021

Additional Information

Authorized Official

Authorized Official Last Name:
NEEDUM
Authorized Official First Name:
QWAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
410-262-4822

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 919255 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: LC7575 . This is a "LICENSED CLINICAL PROFESSIONAL COUNSELOR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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