Healthcare Provider Details

I. General information

NPI: 1508295122
Provider Name (Legal Business Name): SECOND CHANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6519 CENTRAL AVE
NEWARK CA
94560-3932
US

IV. Provider business mailing address

6519 CENTRAL AVE
NEWARK CA
94560-3932
US

V. Phone/Fax

Practice location:
  • Phone: 510-792-4357
  • Fax:
Mailing address:
  • Phone: 510-792-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN M BALENTINE
Title or Position: PROGRAM MANAGER
Credential:
Phone: 510-792-4357