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General NPI Number Information
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NPI Number | 1104141779
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Entity Type | Organization
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Legal Business Name | ANOTHER CHANCE ENTERPRISE
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 04/07/2010
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Provider Practice Location Address
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Address Line | 3001 ARMAND ST SUITE E
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City | MONROE
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State | LA
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Zip | 71201-3754
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Country | US
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Telephone | 318-325-9503
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Fax | 318-325-9504
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Provider Business Mailing Address
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Address Line | 3001 ARMAND ST SUITE E
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City | MONROE
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State | LA
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Zip | 71201-3754
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Country | US
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Telephone | 318-325-9503
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Fax | 318-325-9504
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. BILLY CLAY FOSTER
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Credential | LCSW
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Telephone | 318-325-9503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | ADC9320
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License Number State | LA
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