Fair Chance LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

FAIR CHANCE LLC

Practice address

909 Bolivia Dr
Gastonia, NC 28054-4310

Phone

(980) 208-8678

NPI assigned

Oct 25, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Vianjae Ayana Johnson, MSW

Title

President of Company

Phone

(980) 208-8678

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698192000000",
    "number": "1184496895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 CHELVESTON DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282086911",
            "telephone_number": "980-208-8678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 BOLIVIA DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544310",
            "telephone_number": "980-208-8678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIR CHANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-25",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "VIANJAE",
        "authorized_official_middle_name": "AYANA",
        "authorized_official_title_or_position": "PRESIDENT OF COMPANY",
        "authorized_official_telephone_number": "980-208-8678",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• In Home Supportive Care Agency in Gastonia, NC
• Providers in Gastonia, NC by specialty
• In Home Supportive Care Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.