Provider Demographics
NPI:1508540501
Name:CHANCE, BRENT
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:CHANCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WARFIELD DR APT 1032
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5504
Mailing Address - Country:US
Mailing Address - Phone:202-230-9394
Mailing Address - Fax:
Practice Address - Street 1:401 WARFIELD DR APT 1032
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-5504
Practice Address - Country:US
Practice Address - Phone:202-230-9394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No372600000XNursing Service Related ProvidersAdult Companion