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General NPI Number Information
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NPI Number | 1104542927
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Entity Type | Organization
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Legal Business Name | CHANCE AT LIFE SUPPORT SERVICES
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 110 DUNSFORD CT
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City | WALKERSVILLE
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State | MD
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Zip | 21793-8252
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Country | US
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Telephone | 443-226-9790
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Fax |
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Provider Business Mailing Address
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Address Line | 915 HOLDEN RD
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City | FREDERICK
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State | MD
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Zip | 21701-3426
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Country | US
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Telephone | 443-226-9790
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JANEL QUARLES
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Credential | OWNER
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Telephone | 443-226-9790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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