=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760751606
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 2ND CHANCE FOR RECOVERY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2011
-----------------------------------------------------
Last Update Date | 03/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2216 S CENTRAL AVE 2218 S. CENTRAL AVE.
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90011-1239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-590-0111
-----------------------------------------------------
Fax | 866-754-1323
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2116 S CENTRAL AVE 2118 S. CENTRAL AVE.
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90011-1237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-590-0111
-----------------------------------------------------
Fax | 866-754-1323
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. OGANES JOHN HAKOPYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-590-0111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------