Provider Demographics
NPI:1104640663
Name:CHANCE FOR LIFE INC.
Entity type:Organization
Organization Name:CHANCE FOR LIFE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLUWAKEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGBUYI
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:202-487-9587
Mailing Address - Street 1:4623 MORNING GLORY TRL
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4264
Mailing Address - Country:US
Mailing Address - Phone:202-487-9587
Mailing Address - Fax:
Practice Address - Street 1:4623 MORNING GLORY TRL
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4264
Practice Address - Country:US
Practice Address - Phone:202-487-9587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities