Provider Demographics
NPI:1659136976
Name:SECOND HANDS REENTRY PROGRAM, LLC
Entity Type:Organization
Organization Name:SECOND HANDS REENTRY PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONTANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TARPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-695-8472
Mailing Address - Street 1:309 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4555
Mailing Address - Country:US
Mailing Address - Phone:336-695-8472
Mailing Address - Fax:
Practice Address - Street 1:4941 U S HIGHWAY 29 STE C
Practice Address - Street 2:
Practice Address - City:BLAIRS
Practice Address - State:VA
Practice Address - Zip Code:24527-2328
Practice Address - Country:US
Practice Address - Phone:336-695-8472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children