Provider Demographics
NPI:1316782337
Name:ANOTHER CHANCE DETOX
Entity type:Organization
Organization Name:ANOTHER CHANCE DETOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHANCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-675-0999
Mailing Address - Street 1:5954 BROADWAY BLVD # 105
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5822
Mailing Address - Country:US
Mailing Address - Phone:214-675-0999
Mailing Address - Fax:833-586-2467
Practice Address - Street 1:20320 STATE HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-5742
Practice Address - Country:US
Practice Address - Phone:469-512-5291
Practice Address - Fax:833-586-2467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility