MEDICARE: NEW CHANCE INC

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	324500000X	Substance Abuse Rehabilitation Facility	068	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	004998	OTHER	KS	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1821020314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW CHANCE INC

Provider Business Mailing Address
First Line	:	2500 E WYATT EARP BLVD
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-7037
Country	:	US
Telephone Number	:	620-225-0476
Fax Number	:	620-225-0433

Provider Business Practice Location Address
First Line	:	2500 E WYATT EARP BLVD
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-7037
Country	:	US
Telephone Number	:	620-225-0476
Fax Number	:	620-225-0433

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. DERISE UNRUH
Credential	:	CDAC II NCACII AAP
Telephone Number	:	620-225-0476

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	08/22/2020

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Directions to “NEW CHANCE INC ” Practice Location

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