Provider Demographics
NPI:1710461413
Name:SECOND CHANCES LLC
Entity Type:Organization
Organization Name:SECOND CHANCES LLC
Other - Org Name:SECOND CHANCES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADELIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-685-7813
Mailing Address - Street 1:23 MAINE AVE STE 750
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-2133
Mailing Address - Country:US
Mailing Address - Phone:510-804-0728
Mailing Address - Fax:510-374-6294
Practice Address - Street 1:23 MAINE AVE STE 750
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-2133
Practice Address - Country:US
Practice Address - Phone:510-685-7813
Practice Address - Fax:510-374-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)