Provider Demographics
NPI:1801416631
Name:CHANCES TRANSITION HOME
Entity Type:Organization
Organization Name:CHANCES TRANSITION HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TERREVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:323-920-4856
Mailing Address - Street 1:1423 W 66TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-2011
Mailing Address - Country:US
Mailing Address - Phone:323-920-4856
Mailing Address - Fax:323-451-8098
Practice Address - Street 1:1423 W 66TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-2011
Practice Address - Country:US
Practice Address - Phone:323-920-4856
Practice Address - Fax:323-451-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care