Provider Demographics
NPI:1710532676
Name:SECOND CHANCE BEHAVIROAL HEALTH
Entity Type:Organization
Organization Name:SECOND CHANCE BEHAVIROAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-622-7347
Mailing Address - Street 1:PO BOX 11974
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85130-0540
Mailing Address - Country:US
Mailing Address - Phone:602-622-7347
Mailing Address - Fax:
Practice Address - Street 1:1126 E YUCCA ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-1204
Practice Address - Country:US
Practice Address - Phone:602-622-7347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility