Provider Demographics
NPI:1093920548
Name:2ND CHANCE RECOVERY CENTER
Entity Type:Organization
Organization Name:2ND CHANCE RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SERLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:206-242-4915
Mailing Address - Street 1:133 SW 153RD ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2311
Mailing Address - Country:US
Mailing Address - Phone:206-242-4915
Mailing Address - Fax:206-242-4975
Practice Address - Street 1:133 SW 153RD ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2311
Practice Address - Country:US
Practice Address - Phone:206-242-4915
Practice Address - Fax:206-242-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17-12840000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health