Provider Demographics
NPI:1891931044
Name:ANOTHER CHANCE RESIDENTIAL, LLC.
Entity Type:Organization
Organization Name:ANOTHER CHANCE RESIDENTIAL, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNELL
Authorized Official - Middle Name:LEVON
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-345-6882
Mailing Address - Street 1:2009 MCKINNON DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-4600
Mailing Address - Country:US
Mailing Address - Phone:919-359-0802
Mailing Address - Fax:
Practice Address - Street 1:232 RUBY RIDGE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-4661
Practice Address - Country:US
Practice Address - Phone:919-598-3175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC032467322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children