| Another Chance Customize Services Inc. | |
|
2412 Park Central Blvd Decatur GA 30035-3901 | |
| (678) 518-1823 | |
| Not Available |
| Full Name | Another Chance Customize Services Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2412 Park Central Blvd, Decatur, Georgia |
| Authorized Official Name and Position | Mang N Ndukwe (CEO) |
| Authorized Official Contact | 6785181823 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Another Chance Customize Services Inc. 2412 Park Central Blvd Decatur GA 30035-3901 Ph: (678) 518-1823 | Another Chance Customize Services Inc. 2412 Park Central Blvd Decatur GA 30035-3901 Ph: (678) 518-1823 |
| NPI Number | 1639452105 |
|---|---|
| Provider Enumeration Date | 09/21/2011 |
| Last Update Date | 09/21/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639452105 | NPI | - | NPPES |
| 690760120 B, C, D, E | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 044-R-0675 (Georgia) | Primary |
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