Provider Demographics
NPI:1508044652
Name:ANOTHER CHOICE, ANOTHER CHANCE
Entity Type:Organization
Organization Name:ANOTHER CHOICE, ANOTHER CHANCE
Other - Org Name:FOLSOM HIGH SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAMS MANAGER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:916-388-9418
Mailing Address - Street 1:7000 FRANKLIN BLVD STE 625
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1884
Mailing Address - Country:US
Mailing Address - Phone:916-388-9418
Mailing Address - Fax:916-388-9273
Practice Address - Street 1:955 RILEY ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3002
Practice Address - Country:US
Practice Address - Phone:916-294-9809
Practice Address - Fax:916-388-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3434Medicaid