Provider Demographics
NPI:1003673617
Name:SECOND CHANCE ADDICTION CARE LLC
Entity Type:Organization
Organization Name:SECOND CHANCE ADDICTION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXA
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:LISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-983-5130
Mailing Address - Street 1:9800 FALLS RD STE 7
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3942
Mailing Address - Country:US
Mailing Address - Phone:301-983-5130
Mailing Address - Fax:855-270-6701
Practice Address - Street 1:9800 FALLS RD STE 7
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3942
Practice Address - Country:US
Practice Address - Phone:301-983-5130
Practice Address - Fax:855-270-6701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SECOND CHANCE ADDICTION CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)