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General NPI Number Information
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NPI Number | 1245784016
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Entity Type | Organization
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Legal Business Name | SECOND CHANCE RECOVERY INCORPORATED
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 11104 WEST AIRPORT BLVD. SUITE 214
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City | STAFFORD
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State | TX
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Zip | 77477
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Country | US
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Telephone | 281-835-4230
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Fax | 315-628-1119
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Provider Business Mailing Address
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Address Line | 11104 WEST AIRPORT BLVD. SUITE 214
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City | STAFFORD
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State | TX
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Zip | 77477
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Country | US
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Telephone | 281-835-4230
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Fax | 315-628-1119
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Authorized Official
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Title or Position | CEO
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Name | THERESA BANNIS
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Credential |
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Telephone | 832-869-8856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 40824083
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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