Provider Demographics
NPI:1780969188
Name:A CHANCE FOR CHANGE, INCORPORATED
Entity type:Organization
Organization Name:A CHANCE FOR CHANGE, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:RODNISHA
Authorized Official - Middle Name:SADE
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-923-9701
Mailing Address - Street 1:334 S VINE STREET
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4052
Mailing Address - Country:US
Mailing Address - Phone:704-923-9701
Mailing Address - Fax:
Practice Address - Street 1:334 S VINE ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-3575
Practice Address - Country:US
Practice Address - Phone:704-923-9701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health