Provider Demographics
NPI:1407034564
Name:ANOTHER CHOICE, ANOTHER CHANCE
Entity Type:Organization
Organization Name:ANOTHER CHOICE, ANOTHER CHANCE
Other - Org Name:GENISIS CHARTER SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VANNESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:ADD
Authorized Official - Phone:916-361-2089
Mailing Address - Street 1:2801 ARAMON DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4803
Mailing Address - Country:US
Mailing Address - Phone:916-361-2089
Mailing Address - Fax:916-388-9273
Practice Address - Street 1:5601 47TH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95824-4031
Practice Address - Country:US
Practice Address - Phone:916-433-5300
Practice Address - Fax:916-388-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3434251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3434Medicaid