Healthcare Provider Details

I. General information

NPI: 1558074708
Provider Name (Legal Business Name): CHANCETOTAKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GONZALITOS MESA RD
MIAMI NM
87729-2106
US

IV. Provider business mailing address

40 GONZALITOS MESA RD
MIAMI NM
87729-2106
US

V. Phone/Fax

Practice location:
  • Phone: 575-207-5234
  • Fax: 575-207-5234
Mailing address:
  • Phone: 575-207-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MORGAN NICOLE SABLOTNY
Title or Position: OWNER
Credential: LCSW
Phone: 575-207-5234