Provider Demographics
NPI:1043075583
Name:SECOND CHANCE BEHAVIORAL HEALTH CENTER LLC
Entity Type:Organization
Organization Name:SECOND CHANCE BEHAVIORAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-504-9048
Mailing Address - Street 1:224 PHILLIP MORRIS DR UNIT 300-302
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1964
Mailing Address - Country:US
Mailing Address - Phone:410-504-9048
Mailing Address - Fax:
Practice Address - Street 1:224 PHILLIP MORRIS DR UNIT 300-302
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1964
Practice Address - Country:US
Practice Address - Phone:410-504-9048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility