Basic Information
| Provider Information | |||||||||
| NPI: | 1982988945 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANOTHER CHOICE ANOTHER CHANCE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5450 POWER INN RD STE B | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958206749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163889418 | ||||||||
| FaxNumber: | 9163889273 | ||||||||
| Practice Location | |||||||||
| Address1: | 5701 BROADWAY STE 6 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958201801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163889418 | ||||||||
| FaxNumber: | 9163889273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2011 | ||||||||
| LastUpdateDate: | 01/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | CANNON | ||||||||
| AuthorizedOfficialFirstName: | STAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAMS MANAGER/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9163889418 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CADC II | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.