Provider Demographics
NPI:1316207087
Name:FIRST &SECOND CHANCE ADULT CARE SERVICES INC.
Entity Type:Organization
Organization Name:FIRST &SECOND CHANCE ADULT CARE SERVICES INC.
Other - Org Name:LIM'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:EDWARDS
Authorized Official - Last Name:BERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-252-4094
Mailing Address - Street 1:401 JACKSON PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-3655
Mailing Address - Country:US
Mailing Address - Phone:704-252-4094
Mailing Address - Fax:
Practice Address - Street 1:401 JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-3655
Practice Address - Country:US
Practice Address - Phone:704-252-4094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL013169261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health