Provider Demographics
NPI:1952655565
Name:SECOND CHANCE RECOVERY CENTER INC.
Entity Type:Organization
Organization Name:SECOND CHANCE RECOVERY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:THURMAN
Authorized Official - Last Name:CRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-295-8710
Mailing Address - Street 1:100 WOODCOVE LN
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-8173
Mailing Address - Country:US
Mailing Address - Phone:980-295-8710
Mailing Address - Fax:
Practice Address - Street 1:100 WOODCOVE LN
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-8173
Practice Address - Country:US
Practice Address - Phone:980-295-8710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-04
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children