Provider Demographics
NPI:1609919190
Name:ANOTHER CHOICE ANOTHER CHANCE
Entity Type:Organization
Organization Name:ANOTHER CHOICE ANOTHER CHANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:YOUTH ADVOCATE
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:AGUSTIN
Authorized Official - Last Name:CARDENAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-862-3615
Mailing Address - Street 1:10447 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2279
Mailing Address - Country:US
Mailing Address - Phone:916-635-6635
Mailing Address - Fax:
Practice Address - Street 1:2801 ARAMON DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-4803
Practice Address - Country:US
Practice Address - Phone:916-361-2089
Practice Address - Fax:916-361-2091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171M00000XOtherCASE MANAGER