Healthcare Provider Details

I. General information

NPI: 1184554479
Provider Name (Legal Business Name): CHANCE FOR CHANGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ALBION ST
WEST WARWICK RI
02893-3202
US

IV. Provider business mailing address

10 ALBION ST
WEST WARWICK RI
02893-3202
US

V. Phone/Fax

Practice location:
  • Phone: 401-837-4657
  • Fax: 401-837-4657
Mailing address:
  • Phone: 401-837-4657
  • Fax: 401-837-4657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SAMMEYJOE MONTEIRO GONCALVES
Title or Position: OWNER
Credential: SAMMEYJOE GONCALVES
Phone: 401-837-4657