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General NPI Number Information
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NPI Number | 1669690962
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Entity Type | Organization
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Legal Business Name | ANOTHER CHANCE ENTERPRISE PCA SERVICES
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 208 COLE AVE
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City | MONROE
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State | LA
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Zip | 71203-3814
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Country | US
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Telephone | 318-342-8404
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Fax | 318-342-8406
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Provider Business Mailing Address
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Address Line | 208 COLE AVE.
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City | MONROE
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State | LA
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Zip | 71201
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Country | US
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Telephone | 318-342-8404
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Fax | 318-342-8406
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. CHRISTOPHER JEROI THOMAS
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Credential |
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Telephone | 318-342-8404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 6953
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License Number State | LA
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