Provider Demographics
NPI:1508044355
Name:ANOTHER CHOICE, ANOTHER CHANCE
Entity Type:Organization
Organization Name:ANOTHER CHOICE, ANOTHER CHANCE
Other - Org Name:JAMES RUTTER MIDDLE SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAMS MANAGER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:916-388-9418
Mailing Address - Street 1:5415 FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2105
Mailing Address - Country:US
Mailing Address - Phone:916-361-2089
Mailing Address - Fax:
Practice Address - Street 1:7350 PALMER HOUSE DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-4027
Practice Address - Country:US
Practice Address - Phone:916-422-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3432251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3432Medicaid