Provider Demographics
NPI:1568177863
Name:ANOTHER CHANCE THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:ANOTHER CHANCE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:937-765-6790
Mailing Address - Street 1:PO BOX 75414
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67275-5414
Mailing Address - Country:US
Mailing Address - Phone:937-765-6790
Mailing Address - Fax:
Practice Address - Street 1:560 S TURQUOISE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-1707
Practice Address - Country:US
Practice Address - Phone:937-765-6790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0337296Medicaid