Healthcare Provider Details

I. General information

NPI: 1659136976
Provider Name (Legal Business Name): SECOND HANDS REENTRY PROGRAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4941 U S HIGHWAY 29 STE C
BLAIRS VA
24527-2328
US

IV. Provider business mailing address

309 TYLER AVE
DANVILLE VA
24541-4555
US

V. Phone/Fax

Practice location:
  • Phone: 336-695-8472
  • Fax:
Mailing address:
  • Phone: 336-695-8472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MONTANA M TARPLEY
Title or Position: OWNER/CEO
Credential:
Phone: 336-695-8472