MEDICARE: CHANCES MAKE CHAMPIONS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1356208193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANCES MAKE CHAMPIONS LLC

Provider Business Mailing Address
First Line	:	4485 CANAAN PLACE DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-3048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4485 CANAAN PLACE DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-3048
Country	:	US
Telephone Number	:	414-243-0024
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHELSEY DAVIS
Credential	:
Telephone Number	:	414-243-0024

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/20/2026

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Directions to “CHANCES MAKE CHAMPIONS LLC ” Practice Location

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