Healthcare Provider Details

I. General information

NPI: 1841070455
Provider Name (Legal Business Name): SURE CHANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BELMONT AVE
BELMONT NC
28012-2314
US

IV. Provider business mailing address

3540 TORINGDON WAY STE 200
CHARLOTTE NC
28277-4650
US

V. Phone/Fax

Practice location:
  • Phone: 844-246-3100
  • Fax:
Mailing address:
  • Phone: 844-246-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHANTEE SIMMONS
Title or Position: CEO
Credential:
Phone: 844-246-3100