Provider Demographics
NPI:1982837944
Name:SECOND CHANCE FOR YOUTH, LLC
Entity Type:Organization
Organization Name:SECOND CHANCE FOR YOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-665-6726
Mailing Address - Street 1:6207 SHADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-4745
Mailing Address - Country:US
Mailing Address - Phone:804-665-6726
Mailing Address - Fax:
Practice Address - Street 1:6207 SHADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-4745
Practice Address - Country:US
Practice Address - Phone:804-665-6726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1059 14-001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities