Provider Demographics
NPI:1750769683
Name:SECOND CHANCE HOMES
Entity type:Organization
Organization Name:SECOND CHANCE HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OKEZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WACHUKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-339-6101
Mailing Address - Street 1:17300 SCHAEFER HWY # A-2
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-4133
Mailing Address - Country:US
Mailing Address - Phone:586-339-6101
Mailing Address - Fax:
Practice Address - Street 1:17300 SCHAEFER HWY # A-2
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-4133
Practice Address - Country:US
Practice Address - Phone:586-339-6101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARY KATHERINES CHARITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI71608N171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI71608NOtherSTATE OF MICHIGAN