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General NPI Number Information
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NPI Number | 1720265275
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Entity Type | Organization
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Legal Business Name | ANOTHER CHANCE CORPORATION
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 3501 AVENUE K
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City | FORT PIERCE
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State | FL
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Zip | 34947-2307
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Country | US
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Telephone | 772-466-6911
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Fax | 866-303-5980
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Provider Business Mailing Address
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Address Line | 3501 AVENUE K
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City | FORT PIERCE
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State | FL
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Zip | 34947-2307
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Country | US
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Telephone | 772-466-6911
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Fax | 866-303-5980
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. REGINALD L HENDERSON
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Credential |
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Telephone | 772-466-6911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | FL
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