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General NPI Number Information
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NPI Number | 1538321567
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Entity Type | Organization
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Legal Business Name | SECOND CHANCE LIVING INC
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 3011 S MEMORIAL DR SUITE #11
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City | GREENVILLE
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State | NC
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Zip | 27834-6238
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Country | US
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Telephone | 252-814-1899
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Fax |
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Provider Business Mailing Address
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Address Line | 3011 S MEMORIAL DR SUITE #11
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City | GREENVILLE
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State | NC
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Zip | 27834-6238
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Country | US
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Telephone | 252-814-1899
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BAKARRI K JOHNSON
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Credential | B,A.
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Telephone | 252-814-1899
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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 |
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License Number State |
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