Provider Demographics
NPI:1922273697
Name:SECOND CHANCE CENTER NM
Entity Type:Organization
Organization Name:SECOND CHANCE CENTER NM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-991-6961
Mailing Address - Street 1:1497 MAIN ST # 302
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-4612
Mailing Address - Country:US
Mailing Address - Phone:727-784-1084
Mailing Address - Fax:727-784-1084
Practice Address - Street 1:7440 JIM MCDOWELL ROAD
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121
Practice Address - Country:US
Practice Address - Phone:505-836-4025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care