Provider Demographics
NPI:1083821417
Name:ANOTHER CHANCE ENTERPRISE PCA SERVICES
Entity Type:Organization
Organization Name:ANOTHER CHANCE ENTERPRISE PCA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JEROI
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-342-8404
Mailing Address - Street 1:208 COLE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-3814
Mailing Address - Country:US
Mailing Address - Phone:318-342-8404
Mailing Address - Fax:318-342-8406
Practice Address - Street 1:208 COLE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-3814
Practice Address - Country:US
Practice Address - Phone:318-342-8404
Practice Address - Fax:318-342-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6953320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1506761Medicaid