Provider Demographics
NPI:1932515087
Name:2ND CHANZS
Entity Type:Organization
Organization Name:2ND CHANZS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SEKOU
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, CPM
Authorized Official - Phone:623-478-9400
Mailing Address - Street 1:9950 W VAN BUREN ST
Mailing Address - Street 2:SUITE B135
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-5322
Mailing Address - Country:US
Mailing Address - Phone:623-478-9400
Mailing Address - Fax:
Practice Address - Street 1:1214 E JEN DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-0757
Practice Address - Country:US
Practice Address - Phone:623-478-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUCCESSFUL JOURNEYS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness