MEDICARE: SECOND CHANCE RECOVERY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	251S00000X	Community/Behavioral Health Agency
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1164987376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND CHANCE RECOVERY INC

Provider Business Mailing Address
First Line	:	1135 E ROUTE 66 STE 209
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91740-3778
Country	:	US
Telephone Number	:	626-353-4289
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 E ROUTE 66 STE 209
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91740-3778
Country	:	US
Telephone Number	:	626-353-4289
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	AMY ROBERTS
Credential	:
Telephone Number	:	626-353-4289

Provider Enumeration Date	:	02/01/2019
Last Update Date	:	02/01/2019

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Directions to “SECOND CHANCE RECOVERY INC ” Practice Location

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