Provider Demographics
NPI:1245070242
Name:ANOTHER CHANCE MH-SU SERVICES
Entity type:Organization
Organization Name:ANOTHER CHANCE MH-SU SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBES
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:252-775-1786
Mailing Address - Street 1:109 PINEHURST LN
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8178
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 PINEHURST LN
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-8178
Practice Address - Country:US
Practice Address - Phone:252-775-1786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health