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General NPI Number Information
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NPI Number | 1811242480
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Entity Type | Organization
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Legal Business Name | FIRST & SECOND CHANCE ADULT CARE SERVICES INC.
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 401 JACKSON PARK RD
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City | KANNAPOLIS
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State | NC
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Zip | 28083-3655
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Country | US
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Telephone | 704-252-4094
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Fax |
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Provider Business Mailing Address
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Address Line | 1185 DALE EARNHARDT BLVD
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City | KANNAPOLIS
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State | NC
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Zip | 28083-3201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHARON EDWARDS BERRYMAN
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Credential |
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Telephone | 704-252-4094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MHL-013-170
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License Number State | NC
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