Provider Demographics
NPI:1376164517
Name:SECOND CHANCE OPPORTUNITY REINTEGRATION ENTITY SYSTEMS, LLC
Entity Type:Organization
Organization Name:SECOND CHANCE OPPORTUNITY REINTEGRATION ENTITY SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ENGERD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARELA
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSE SOCIAL WORK
Authorized Official - Phone:201-850-2661
Mailing Address - Street 1:92 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3599
Mailing Address - Country:US
Mailing Address - Phone:201-893-6397
Mailing Address - Fax:
Practice Address - Street 1:92 WAYNE ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3599
Practice Address - Country:US
Practice Address - Phone:201-893-6397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty