Provider Demographics
NPI:1689221582
Name:SECOND OPPORTUNITY LLC
Entity Type:Organization
Organization Name:SECOND OPPORTUNITY LLC
Other - Org Name:SECOND OPPORTUNITY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-538-3551
Mailing Address - Street 1:3769 THE GREAT DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8726
Mailing Address - Country:US
Mailing Address - Phone:404-538-3551
Mailing Address - Fax:
Practice Address - Street 1:3769 THE GREAT DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-8726
Practice Address - Country:US
Practice Address - Phone:404-538-3551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-25
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty