Provider Demographics
NPI:1245784016
Name:SECOND CHANCE RECOVERY INCORPORATED
Entity Type:Organization
Organization Name:SECOND CHANCE RECOVERY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-869-8856
Mailing Address - Street 1:11104 WEST AIRPORT BLVD. SUITE 214
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477
Mailing Address - Country:US
Mailing Address - Phone:281-835-4230
Mailing Address - Fax:315-628-1119
Practice Address - Street 1:11104 WEST AIRPORT BLVD. SUITE 214
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477
Practice Address - Country:US
Practice Address - Phone:281-835-4230
Practice Address - Fax:315-628-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40824083261QR0405X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder