Provider Demographics
NPI:1356778906
Name:HOME OF SECOND CHANCES
Entity type:Organization
Organization Name:HOME OF SECOND CHANCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CST TEAM LEAD/SAIOP/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS-A
Authorized Official - Phone:336-285-9031
Mailing Address - Street 1:2300 W MEADOWVIEW RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3720
Mailing Address - Country:US
Mailing Address - Phone:336-285-9031
Mailing Address - Fax:
Practice Address - Street 1:2300 W MEADOWVIEW RD
Practice Address - Street 2:SUITE 206
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3720
Practice Address - Country:US
Practice Address - Phone:336-285-9031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2821-A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health