Provider Demographics
NPI:1558516955
Name:ANOTHER CHANCE
Entity Type:Organization
Organization Name:ANOTHER CHANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-442-4706
Mailing Address - Street 1:840 HOPEWELL ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27263-2380
Mailing Address - Country:US
Mailing Address - Phone:336-442-4706
Mailing Address - Fax:
Practice Address - Street 1:2807 EARLHAM PL
Practice Address - Street 2:SUITE B
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27263-1948
Practice Address - Country:US
Practice Address - Phone:336-442-4706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
305R00000X305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization