Provider Demographics
NPI:1043079536
Name:SECOND CHANCE RESOURCE CENTER
Entity Type:Organization
Organization Name:SECOND CHANCE RESOURCE CENTER
Other - Org Name:SECOND CHANCE RESOURCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-902-3022
Mailing Address - Street 1:2105 ECHODALE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1927
Mailing Address - Country:US
Mailing Address - Phone:202-902-3022
Mailing Address - Fax:
Practice Address - Street 1:2105 ECHODALE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1927
Practice Address - Country:US
Practice Address - Phone:202-902-3022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No344800000XTransportation ServicesAir Carrier