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General NPI Number Information
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NPI Number | 1841070455
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Entity Type | Organization
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Legal Business Name | SURE CHANCE, LLC
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 101 BELMONT AVE
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City | BELMONT
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State | NC
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Zip | 28012-2314
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Country | US
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Telephone | 844-246-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 3540 TORINGDON WAY STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28277-4650
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Country | US
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Telephone | 844-246-3100
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHANTEE SIMMONS
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Credential |
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Telephone | 844-246-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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