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General NPI Number Information
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NPI Number | 1427334721
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Entity Type | Organization
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Legal Business Name | A SECOND CHANCE
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 707 N FOXDALE AVE
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City | WEST COVINA
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State | CA
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Zip | 91790-1213
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Country | US
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Telephone | 626-430-6197
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Fax | 626-430-7404
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Provider Business Mailing Address
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Address Line | 707 N FOXDALE AVE 714 N. SUNSET AVE
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City | WEST COVINA
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State | CA
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Zip | 91790-1213
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Country | US
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Telephone | 626-430-6197
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Fax | 626-430-7404
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. VAHE A HAKIMIAN
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Credential | ADMIN/PHARMACY TECH
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Telephone | 626-430-6197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | BBS4936
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 162257
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License Number State | CA
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