Provider Demographics
NPI:1255884904
Name:A CHANCE TO CHANGE DRUG AND ALCOHOL TESTING, LLC
Entity type:Organization
Organization Name:A CHANCE TO CHANGE DRUG AND ALCOHOL TESTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:HULETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-881-5298
Mailing Address - Street 1:1260 GRANGER RD
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-9223
Mailing Address - Country:US
Mailing Address - Phone:248-881-5298
Mailing Address - Fax:248-627-6368
Practice Address - Street 1:10 N MORSE ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1125
Practice Address - Country:US
Practice Address - Phone:810-648-9144
Practice Address - Fax:810-537-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management