Provider Demographics
NPI:1760751606
Name:2ND CHANCE FOR RECOVERY INC.
Entity Type:Organization
Organization Name:2ND CHANCE FOR RECOVERY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OGANES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HAKOPYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-590-0111
Mailing Address - Street 1:2116 S CENTRAL AVE
Mailing Address - Street 2:2118 S. CENTRAL AVE.
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-1237
Mailing Address - Country:US
Mailing Address - Phone:818-590-0111
Mailing Address - Fax:866-754-1323
Practice Address - Street 1:2216 S CENTRAL AVE
Practice Address - Street 2:2218 S. CENTRAL AVE.
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-1239
Practice Address - Country:US
Practice Address - Phone:818-590-0111
Practice Address - Fax:866-754-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7404Medicaid