Provider Demographics
NPI:1124703418
Name:SECOND CHANCE ADDICTION CARE
Entity type:Organization
Organization Name:SECOND CHANCE ADDICTION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-723-5018
Mailing Address - Street 1:9800 FALLS RD STE 7
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3942
Mailing Address - Country:US
Mailing Address - Phone:301-983-5130
Mailing Address - Fax:855-270-6701
Practice Address - Street 1:401 E JEFFERSON ST STE 203
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2617
Practice Address - Country:US
Practice Address - Phone:301-983-5130
Practice Address - Fax:855-270-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD500320200Medicaid