Provider Demographics
NPI:1629431283
Name:A CHANCE FOR CHANGE
Entity Type:Organization
Organization Name:A CHANCE FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-241-5335
Mailing Address - Street 1:620 E PLUMB LN
Mailing Address - Street 2:STE 213
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3536
Mailing Address - Country:US
Mailing Address - Phone:916-241-5335
Mailing Address - Fax:
Practice Address - Street 1:620 E PLUMB LN
Practice Address - Street 2:STE 213
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3536
Practice Address - Country:US
Practice Address - Phone:916-241-5335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health