Another Chance Customize Services Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

044-R-0675 Issued in GA

Legal business name

ANOTHER CHANCE CUSTOMIZE SERVICES INC.

Practice address

2412 Park Central Blvd
Decatur, GA 30035-3901

Phone

(678) 518-1823

NPI assigned

Sep 21, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Mang N Ndukwe, PHD

Title

Ceo

Phone

(678) 518-1823

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1316563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316563200000",
    "number": "1639452105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2412 PARK CENTRAL BLVD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300353901",
            "telephone_number": "678-518-1823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2412 PARK CENTRAL BLVD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300353901",
            "telephone_number": "678-518-1823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANOTHER CHANCE CUSTOMIZE SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-21",
        "last_updated": "2011-09-21",
        "status": "A",
        "authorized_official_last_name": "NDUKWE",
        "authorized_official_first_name": "MANG",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-518-1823",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "044-R-0675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "690760120 B, C, D, E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Decatur, GA
• Providers in Decatur, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; 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.