Provider Demographics
NPI:1629704184
Name:2ND CHANCE REDISCOVERY
Entity Type:Organization
Organization Name:2ND CHANCE REDISCOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-478-2044
Mailing Address - Street 1:1851 SHOSHONE DR
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-8115
Mailing Address - Country:US
Mailing Address - Phone:171-447-8204
Mailing Address - Fax:
Practice Address - Street 1:1851 SHOSHONE DR
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-8115
Practice Address - Country:US
Practice Address - Phone:171-447-8204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SINFULXVANITY ART AND DESIGN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No1744G0900XOther Service ProvidersSpecialistGraphics DesignerGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty