MEDICARE: FIGHTING CHANCE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1639408156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIGHTING CHANCE, INC

Provider Business Mailing Address
First Line	:	PO BOX 1358
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-0049
Country	:	US
Telephone Number	:	631-725-4646
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 HAMPTON ST
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-4241
Country	:	US
Telephone Number	:	631-725-4646
Fax Number	:	631-725-5731

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	DUNCAN N DARROW
Credential	:
Telephone Number	:	631-725-4646

Provider Enumeration Date	:	12/11/2009
Last Update Date	:	12/11/2009

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Directions to “FIGHTING CHANCE, INC ” Practice Location

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