Provider Demographics
NPI:1578541157
Name:SECOND WIND, INC.
Entity Type:Organization
Organization Name:SECOND WIND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CAC-AD
Authorized Official - Phone:410-749-8038
Mailing Address - Street 1:309 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5308
Mailing Address - Country:US
Mailing Address - Phone:410-749-8038
Mailing Address - Fax:410-749-8040
Practice Address - Street 1:309 NEWTON ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5308
Practice Address - Country:US
Practice Address - Phone:410-749-8038
Practice Address - Fax:410-749-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10760324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility