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General NPI Number Information
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NPI Number | 1164815106
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Entity Type | Organization
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Legal Business Name | CHANCE 2 CHANGE
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 724 S BEACH ST SUITE 3
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-5441
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Country | US
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Telephone | 386-437-0235
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Fax |
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Provider Business Mailing Address
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Address Line | 4721 E MOODY BLVD STE 107
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City | BUNNELL
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State | FL
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Zip | 32110-7705
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Country | US
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Telephone | 386-437-0235
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KIM JONES
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Credential |
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Telephone | 386-437-0235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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