Provider Demographics
NPI:1609039858
Name:NEW OUTLOOK..SECOND CHANCE, INC.
Entity Type:Organization
Organization Name:NEW OUTLOOK..SECOND CHANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETHENA
Authorized Official - Middle Name:MESHEL
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:919-885-2566
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702-0802
Mailing Address - Country:US
Mailing Address - Phone:919-885-2566
Mailing Address - Fax:919-794-8171
Practice Address - Street 1:1005 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4143
Practice Address - Country:US
Practice Address - Phone:919-885-2566
Practice Address - Fax:919-794-8171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health