Provider Demographics
NPI:1245935337
Name:ANOTHER CHANCE SUPPORTIVE SERVICES
Entity type:Organization
Organization Name:ANOTHER CHANCE SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-310-1079
Mailing Address - Street 1:6305 BELAIR RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-1817
Mailing Address - Country:US
Mailing Address - Phone:667-310-1079
Mailing Address - Fax:
Practice Address - Street 1:6305 BELAIR RD STE 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-1817
Practice Address - Country:US
Practice Address - Phone:667-310-1079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health