Provider Demographics
NPI:1386986081
Name:SECOND CHANCE INTERNATIONAL MINISTRIES, INC
Entity type:Organization
Organization Name:SECOND CHANCE INTERNATIONAL MINISTRIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNES
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:678-925-1054
Mailing Address - Street 1:4848A OLD NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-6233
Mailing Address - Country:US
Mailing Address - Phone:678-814-3358
Mailing Address - Fax:678-759-0711
Practice Address - Street 1:4848A OLD NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-6233
Practice Address - Country:US
Practice Address - Phone:678-814-3358
Practice Address - Fax:678-759-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16097130251B00000X
GAT0039251S00000X, 324500000X
343900000X, 347C00000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker