Provider Demographics
NPI:1578625786
Name:CSA ENTERPRISE, INC.
Entity Type:Organization
Organization Name:CSA ENTERPRISE, INC.
Other - Org Name:2ND CHANCE REHAB & BEHAVIORAL SERVICE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DWANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:214-552-8128
Mailing Address - Street 1:3309 SEDONA LANE
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070
Mailing Address - Country:US
Mailing Address - Phone:214-552-8128
Mailing Address - Fax:972-542-8799
Practice Address - Street 1:3309 SEDONA LN
Practice Address - Street 2:15707C COIT RD STE 119
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4455
Practice Address - Country:US
Practice Address - Phone:214-552-8128
Practice Address - Fax:972-542-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3754251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management