Provider Demographics
NPI:1790238715
Name:SECOND CHANCE INTERVENTIONS (SCI) PLLC
Entity Type:Organization
Organization Name:SECOND CHANCE INTERVENTIONS (SCI) PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:406-755-5400
Mailing Address - Street 1:PO BOX 11115
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-4115
Mailing Address - Country:US
Mailing Address - Phone:406-755-5400
Mailing Address - Fax:
Practice Address - Street 1:38 E WASHINGTON ST STE 6
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3974
Practice Address - Country:US
Practice Address - Phone:406-755-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health