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General NPI Number Information
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NPI Number | 1093920548
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Entity Type | Organization
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Legal Business Name | 2ND CHANCE RECOVERY CENTER
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 133 SW 153RD ST
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City | BURIEN
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State | WA
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Zip | 98166-2311
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Country | US
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Telephone | 206-242-4915
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Fax | 206-242-4975
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Provider Business Mailing Address
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Address Line | 133 SW 153RD ST
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City | BURIEN
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State | WA
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Zip | 98166-2311
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Country | US
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Telephone | 206-242-4915
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Fax | 206-242-4975
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Authorized Official
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Title or Position | TREATMENT DIRECTOR
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Name | MR. PETER MICHAEL SERLETTI
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Credential | CDP
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Telephone | 206-242-4915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 17-12840000
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License Number State | WA
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