Healthcare Provider Details

I. General information

NPI: 1982523585
Provider Name (Legal Business Name): SECOND PHASE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S FOUR MILE RUN RD
AUSTINTOWN OH
44515-3123
US

IV. Provider business mailing address

191 S FOUR MILE RUN RD
AUSTINTOWN OH
44515-3123
US

V. Phone/Fax

Practice location:
  • Phone: 330-797-9930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE RICHARDS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 330-797-9930