MEDICARE: 2ND CHANCE FOR RECOVERY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003077710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2ND CHANCE FOR RECOVERY, INC.

Provider Business Mailing Address
First Line	:	22218 CORALBELL LN
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-7211
Country	:	US
Telephone Number	:	818-590-0111
Fax Number	:	866-754-1323

Provider Business Practice Location Address
First Line	:	600 E 7TH ST # 104-105
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90021-1436
Country	:	US
Telephone Number	:	818-590-0111
Fax Number	:	866-754-1323

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. OGANES JOHN HAKOPYAN
Credential	:
Telephone Number	:	818-590-0111

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	04/19/2012

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