Healthcare Provider Details

I. General information

NPI: 1841741501
Provider Name (Legal Business Name): SECOND CHANCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 WICKENDEN ST
PROVIDENCE RI
02903-4425
US

IV. Provider business mailing address

PO BOX 120081
BOSTON MA
02112-0081
US

V. Phone/Fax

Practice location:
  • Phone: 877-557-3155
  • Fax:
Mailing address:
  • Phone: 617-838-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT S AMEIDA
Title or Position: PRESIDENT
Credential: DC
Phone: 617-838-8650