Provider Demographics
NPI:1780492371
Name:I MADE THE CHOICE 2 CHANGE, INC
Entity type:Organization
Organization Name:I MADE THE CHOICE 2 CHANGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRESURE
Authorized Official - Prefix:
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:SUDCC
Authorized Official - Phone:916-429-5754
Mailing Address - Street 1:4046 73RD ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-3521
Mailing Address - Country:US
Mailing Address - Phone:916-429-5754
Mailing Address - Fax:
Practice Address - Street 1:4046 73RD ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-3521
Practice Address - Country:US
Practice Address - Phone:916-429-5754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health