Provider Demographics
NPI:1760615041
Name:A 2ND CHANCE RECOVERY CENTER, INC.
Entity Type:Organization
Organization Name:A 2ND CHANCE RECOVERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-804-3551
Mailing Address - Street 1:424 VANCE LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-0368
Mailing Address - Country:US
Mailing Address - Phone:866-374-4673
Mailing Address - Fax:615-453-2609
Practice Address - Street 1:5607 RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:EAST RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37412-3131
Practice Address - Country:US
Practice Address - Phone:866-374-4673
Practice Address - Fax:615-453-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder