Provider Demographics
NPI:1548582349
Name:2ND CHANCE COMMUNITY SUPPORT OUTREACH
Entity Type:Organization
Organization Name:2ND CHANCE COMMUNITY SUPPORT OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:HARRIETT
Authorized Official - Middle Name:
Authorized Official - Last Name:SILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-449-4344
Mailing Address - Street 1:308 ST NICHOLAS TRL
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-2780
Mailing Address - Country:US
Mailing Address - Phone:336-449-4344
Mailing Address - Fax:336-449-4344
Practice Address - Street 1:308 ST NICHOLAS TRL
Practice Address - Street 2:
Practice Address - City:GIBSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27249-2780
Practice Address - Country:US
Practice Address - Phone:336-449-4344
Practice Address - Fax:336-449-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No347C00000XTransportation ServicesPrivate Vehicle