Provider Demographics
NPI:1326217795
Name:A CHANCE TO CHANGE FOUNDATION
Entity Type:Organization
Organization Name:A CHANCE TO CHANGE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-840-9000
Mailing Address - Street 1:2113 W BRITTON RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1505
Mailing Address - Country:US
Mailing Address - Phone:405-840-9000
Mailing Address - Fax:405-840-9027
Practice Address - Street 1:2113 W BRITTON RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1505
Practice Address - Country:US
Practice Address - Phone:405-840-9000
Practice Address - Fax:405-840-9027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X
OK251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK291655Medicare PIN