Provider Demographics
NPI:1265600472
Name:SECOND CHANCE, INC.
Entity type:Organization
Organization Name:SECOND CHANCE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-745-1675
Mailing Address - Street 1:6330 THORNTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-3734
Mailing Address - Country:US
Mailing Address - Phone:510-745-1675
Mailing Address - Fax:
Practice Address - Street 1:6330 THORNTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-3734
Practice Address - Country:US
Practice Address - Phone:510-745-1675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA018060251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health