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General NPI Number Information
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NPI Number | 1003774100
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Entity Type | Organization
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Legal Business Name | SECOND CHANCE COMMUNITY HEALTH
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 732 S 6TH ST STE R
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City | LAS VEGAS
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State | NV
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Zip | 89101-6948
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Country | US
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Telephone | 702-482-8580
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Fax |
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Provider Business Mailing Address
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Address Line | 732 S 6TH ST STE R
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City | LAS VEGAS
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State | NV
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Zip | 89101-6948
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Country | US
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Telephone | 702-482-8580
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLOS CISNEROS
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Credential | LCSW
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Telephone | 702-482-8580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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