MEDICARE: ANOTHER CHANCE LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	251E00000X	Home Health Agency
3	251F00000X	Home Infusion Agency
4	251J00000X	Nursing Care Agency
5	251S00000X	Community/Behavioral Health Agency
6	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
7	320700000X	Physical Disabilities Residential Treatment Facility
8	320800000X	Mental Illness Community Based Residential Treatment Facility
9	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
10	323P00000X	Psychiatric Residential Treatment Facility
11	324500000X	Substance Abuse Rehabilitation Facility
12	177F00000X	Lodging Provider

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255836359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANOTHER CHANCE LLP

Provider Business Mailing Address
First Line	:	6811 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-2274
Country	:	US
Telephone Number	:	216-501-7924
Fax Number	:

Provider Business Practice Location Address
First Line	:	2177 E 80TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-4952
Country	:	US
Telephone Number	:	330-321-9148
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DAIRRA ANISE BOSS
Credential	:
Telephone Number	:	330-321-9148

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	03/29/2018

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Directions to “ANOTHER CHANCE LLP ” Practice Location

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