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General NPI Number Information
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NPI Number | 1194536425
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Entity Type | Organization
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Legal Business Name | SECOND CHANCE HEALTH & WELLNESS LLC
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 11 NORTHTOWN DR STE 225
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City | JACKSON
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State | MS
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Zip | 39211-3698
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Country | US
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Telephone | 601-842-4718
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Fax |
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Provider Business Mailing Address
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Address Line | 15 OAKFORD CT
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City | JACKSON
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State | MS
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Zip | 39211-3050
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEC/FOUNDER
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Name | DEVIN FOSTER
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Credential |
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Telephone | 601-842-4718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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