Healthcare Provider Details

I. General information

NPI: 1528111317
Provider Name (Legal Business Name): ANOTHER CHANCE ENTERPRISE PER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 COLE AVE
MONROE LA
71203-3814
US

IV. Provider business mailing address

208 COLE AVE
MONROE LA
71203-3814
US

V. Phone/Fax

Practice location:
  • Phone: 318-342-8404
  • Fax: 318-342-8406
Mailing address:
  • Phone: 318-342-8404
  • Fax: 318-342-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number6937
License Number StateLA

VIII. Authorized Official

Name: MR. CHRISTOPHER JEROI THOMAS
Title or Position: ADMINISTATOR
Credential:
Phone: 318-342-8404