Provider Demographics
NPI:1225391105
Name:SECOND CHANCES TCM
Entity Type:Organization
Organization Name:SECOND CHANCES TCM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANQUAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL-GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-460-3731
Mailing Address - Street 1:1706 E SEMORAN BLVD
Mailing Address - Street 2:SUITE102
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5651
Mailing Address - Country:US
Mailing Address - Phone:407-464-2111
Mailing Address - Fax:407-464-2112
Practice Address - Street 1:1706 E SEMORAN BLVD
Practice Address - Street 2:SUITE102
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5651
Practice Address - Country:US
Practice Address - Phone:407-464-2111
Practice Address - Fax:407-464-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management