Healthcare Provider Details

I. General information

NPI: 1659057503
Provider Name (Legal Business Name): GIVE CHANCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PEGASUS AVE
NORTHVALE NJ
07647
US

IV. Provider business mailing address

235 PEGASUS AVE
NORTHVALE NJ
07647
US

V. Phone/Fax

Practice location:
  • Phone: 201-266-0640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNA LEE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 201-560-7781