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General NPI Number Information
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NPI Number | 1447686647
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Entity Type | Organization
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Legal Business Name | HOME OF SECOND CHANCES
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 2300 W MEADOWVIEW RD
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City | GREENSBORO
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State | NC
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Zip | 27407-3720
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Country | US
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Telephone | 336-285-9031
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 W MEADOWVIEW RD
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City | GREENSBORO
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State | NC
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Zip | 27407-3720
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Country | US
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Telephone | 336-285-9031
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Fax |
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Authorized Official
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Title or Position | IIH TEAM LEAD
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Name | MR. TERRY CARTER
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Credential | LCSW
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Telephone | 336-285-9031
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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 | C008103
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License Number State | NC
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