Provider Demographics
NPI:1558074708
Name:CHANCETOTAKE LLC
Entity Type:Organization
Organization Name:CHANCETOTAKE LLC
Other - Org Name:MORGAN SABLOTNY LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SABLOTNY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-207-5234
Mailing Address - Street 1:40 GONZALITOS MESA RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:NM
Mailing Address - Zip Code:87729-2106
Mailing Address - Country:US
Mailing Address - Phone:575-207-5234
Mailing Address - Fax:
Practice Address - Street 1:40 GONZALITOS MESA RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:NM
Practice Address - Zip Code:87729-2106
Practice Address - Country:US
Practice Address - Phone:575-207-5234
Practice Address - Fax:575-207-5234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42331749Medicaid