Provider Demographics
NPI:1972283075
Name:CHANCES 4 CHANGE, INC.
Entity Type:Organization
Organization Name:CHANCES 4 CHANGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MECHILLE
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-277-4684
Mailing Address - Street 1:1171 E ALOSTA AVE # 252
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2740
Mailing Address - Country:US
Mailing Address - Phone:323-997-4419
Mailing Address - Fax:
Practice Address - Street 1:1151 W ARROW HWY APT F63
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-5158
Practice Address - Country:US
Practice Address - Phone:323-997-4419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251B00000XAgenciesCase Management