1649562976 NPI number — ANOTHER CHANCE ENTERPRISE, INC.

Table of content: (NPI 1649562976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649562976 NPI number — ANOTHER CHANCE ENTERPRISE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANOTHER CHANCE ENTERPRISE, INC.
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:
ANOTHER CHANCE ENTERPRISE ADULT SERVICES
Provider Other Organization Name Type Code:
3
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:
1649562976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 ARMAND ST STE D&E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71201-3754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-325-9503
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-649-2855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
BILLY
Authorized Official Middle Name:
CLAY
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
318-325-9503

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1326282856 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1245448992 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1184863380 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1083821417 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1669690962 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548498629 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".