Healthcare Provider Details

I. General information

NPI: 1922273697
Provider Name (Legal Business Name): SECOND CHANCE CENTER NM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 JIM MCDOWELL ROAD
ALBUQUERQUE NM
87121
US

IV. Provider business mailing address

1497 MAIN ST # 302
DUNEDIN FL
34698-4612
US

V. Phone/Fax

Practice location:
  • Phone: 505-836-4025
  • Fax:
Mailing address:
  • Phone: 727-784-1084
  • Fax: 727-784-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK PENDRY
Title or Position: MANAGER
Credential:
Phone: 505-991-6961