Provider Demographics
NPI:1669837175
Name:SECOND CHANCES CM, LLC
Entity Type:Organization
Organization Name:SECOND CHANCES CM, LLC
Other - Org Name:SECOND CHANCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-502-8051
Mailing Address - Street 1:16687 SAINT CLAIR AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9401
Mailing Address - Country:US
Mailing Address - Phone:330-398-1076
Mailing Address - Fax:
Practice Address - Street 1:16687 SAINT CLAIR AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9401
Practice Address - Country:US
Practice Address - Phone:330-398-1076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty