Provider Demographics
NPI:1912582701
Name:SECONG CHANCE TRANSITIONAL LIVING INC
Entity Type:Organization
Organization Name:SECONG CHANCE TRANSITIONAL LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAHISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-206-0026
Mailing Address - Street 1:10816 BERE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6644
Mailing Address - Country:US
Mailing Address - Phone:646-206-0026
Mailing Address - Fax:
Practice Address - Street 1:10816 BERE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-6644
Practice Address - Country:US
Practice Address - Phone:646-206-0026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty