Provider Demographics
NPI:1821020314
Name:NEW CHANCE INC
Entity Type:Organization
Organization Name:NEW CHANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DERISE
Authorized Official - Middle Name:
Authorized Official - Last Name:UNRUH
Authorized Official - Suffix:
Authorized Official - Credentials:CDAC II NCACII AAP
Authorized Official - Phone:620-225-0476
Mailing Address - Street 1:2500 E WYATT EARP BLVD
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-7037
Mailing Address - Country:US
Mailing Address - Phone:620-225-0476
Mailing Address - Fax:620-225-0433
Practice Address - Street 1:2500 E WYATT EARP BLVD
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-7037
Practice Address - Country:US
Practice Address - Phone:620-225-0476
Practice Address - Fax:620-225-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS068324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS004998OtherBLUE CROSS BLUE SHIELD