MEDICARE: NEW OUTLOOK..SECOND CHANCE, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1609039858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW OUTLOOK..SECOND CHANCE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 802
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27702-0802
Country	:	US
Telephone Number	:	919-885-2566
Fax Number	:	919-794-8171

Provider Business Practice Location Address
First Line	:	1005 BROAD ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-4143
Country	:	US
Telephone Number	:	919-885-2566
Fax Number	:	919-794-8171

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. BETHENA MESHEL JACKSON
Credential	:	B.A.
Telephone Number	:	919-885-2566

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	10/01/2014

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