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General NPI Number Information
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NPI Number | 1093968836
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Entity Type | Organization
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Legal Business Name | A SECOND CHANCE,INC
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Dates
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Enumeration Date | 10/24/2008
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Last Update Date | 10/24/2008
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Provider Practice Location Address
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Address Line | 1209 DUCE DR
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City | GREENVILLE
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State | NC
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Zip | 27834-6566
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Country | US
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Telephone | 252-227-4925
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 DUCE DR
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City | GREENVILLE
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State | NC
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Zip | 27834-6566
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Country | US
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Telephone | 252-227-4925
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHIRLEY ANN SUTTON
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Credential |
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Telephone | 252-412-2554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-074-193
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License Number State | NE
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