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General NPI Number Information
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NPI Number | 1487314753
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Entity Type | Organization
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Legal Business Name | SECOND CHANCE & RECOVERY
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Dates
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Enumeration Date | 12/28/2021
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 3500 POWHATAN ST
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City | LYNCHBURG
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State | VA
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Zip | 24501-6512
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Country | US
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Telephone | 434-219-6394
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Fax | 434-219-6394
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Provider Business Mailing Address
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Address Line | 3500 POWHATAN ST
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City | LYNCHBURG
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State | VA
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Zip | 24501-6512
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Country | US
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Telephone | 434-219-6394
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Fax | 434-219-6394
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. JAY WILLIAMS
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Credential | M.B.A
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Telephone | 434-382-7597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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