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General NPI Number Information
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NPI Number | 1952655565
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Entity Type | Organization
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Legal Business Name | SECOND CHANCE RECOVERY CENTER INC.
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Dates
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Enumeration Date | 11/04/2012
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Last Update Date | 11/04/2012
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Provider Practice Location Address
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Address Line | 100 WOODCOVE LN
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City | SHELBY
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State | NC
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Zip | 28150-8173
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Country | US
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Telephone | 980-295-8710
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Fax |
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Provider Business Mailing Address
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Address Line | 100 WOODCOVE LN
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City | SHELBY
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State | NC
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Zip | 28150-8173
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Country | US
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Telephone | 980-295-8710
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SHARON THURMAN CRANK
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Credential |
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Telephone | 980-295-8710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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