Provider Demographics
NPI:1073993101
Name:NEW START AT SECOND CHANCE
Entity Type:Organization
Organization Name:NEW START AT SECOND CHANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:OSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:702-904-4097
Mailing Address - Street 1:6358 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1142
Mailing Address - Country:US
Mailing Address - Phone:702-506-5352
Mailing Address - Fax:
Practice Address - Street 1:1313 MISTY VIEW CT
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-1053
Practice Address - Country:US
Practice Address - Phone:702-904-4097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty