Healthcare Provider Details

I. General information

NPI: 1801416631
Provider Name (Legal Business Name): CHANCES TRANSITION HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 W 66TH ST
LOS ANGELES CA
90047-2011
US

IV. Provider business mailing address

1423 W 66TH ST
LOS ANGELES CA
90047-2011
US

V. Phone/Fax

Practice location:
  • Phone: 323-920-4856
  • Fax: 323-451-8098
Mailing address:
  • Phone: 323-920-4856
  • Fax: 323-451-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TERREVIA BUCK
Title or Position: CEO
Credential: RN
Phone: 323-920-4856