Provider Demographics
NPI:1205165495
Name:ANOTHER CHANCE, LLC
Entity type:Organization
Organization Name:ANOTHER CHANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CASKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-669-6283
Mailing Address - Street 1:1400 BATTLEGROUND AVE
Mailing Address - Street 2:STE. 150-F
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8042
Mailing Address - Country:US
Mailing Address - Phone:336-669-6283
Mailing Address - Fax:336-698-3849
Practice Address - Street 1:1400 BATTLEGROUND AVE
Practice Address - Street 2:STE. 150-F
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8042
Practice Address - Country:US
Practice Address - Phone:336-669-6283
Practice Address - Fax:336-698-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC221265251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management