Provider Demographics
NPI:1437299104
Name:CHANAN FOUNDATION, INC.
Entity Type:Organization
Organization Name:CHANAN FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-715-8891
Mailing Address - Street 1:6470 CEDAR MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-3505
Mailing Address - Country:US
Mailing Address - Phone:678-715-8891
Mailing Address - Fax:770-489-6517
Practice Address - Street 1:6470 CEDAR MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-3505
Practice Address - Country:US
Practice Address - Phone:678-715-8891
Practice Address - Fax:770-489-6517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities