MEDICARE: 2ND CHANCES NEW BEGINNINGS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1528371283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2ND CHANCES NEW BEGINNINGS LLC

Provider Business Mailing Address
First Line	:	170 W FRANKLIN BLVD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4107
Country	:	US
Telephone Number	:	704-864-7500
Fax Number	:	704-864-2227

Provider Business Practice Location Address
First Line	:	170 W FRANKLIN BLVD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4107
Country	:	US
Telephone Number	:	704-864-7500
Fax Number	:	704-864-2227

Authorized Official
Title or Position	:	OWNER
Name	:	MISS SENORA E SPIKES
Credential	:
Telephone Number	:	704-492-4037

Provider Enumeration Date	:	07/22/2010
Last Update Date	:	12/27/2010

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