Provider Demographics
NPI:1578808432
Name:ANOTHER CHANCE YOUTH MINISTRY
Entity Type:Organization
Organization Name:ANOTHER CHANCE YOUTH MINISTRY
Other - Org Name:LUELLA CHILDS
Other - Org Type:Other Name
Authorized Official - Title/Position:PASTOR / CEO-FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:PASTOR
Authorized Official - Phone:469-324-6253
Mailing Address - Street 1:1622 S BECKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-2004
Mailing Address - Country:US
Mailing Address - Phone:469-324-6253
Mailing Address - Fax:469-206-6611
Practice Address - Street 1:1622 S BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-2004
Practice Address - Country:US
Practice Address - Phone:469-324-6253
Practice Address - Fax:469-206-6611
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANOTHER CHANCE YOUTH MINISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-04
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15089177CDL172A00000X
TX15089177311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care HomeGroup - Single Specialty