Provider Demographics
NPI:1487314753
Name:SECOND CHANCE & RECOVERY
Entity type:Organization
Organization Name:SECOND CHANCE & RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:434-382-7597
Mailing Address - Street 1:3500 POWHATAN ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-6512
Mailing Address - Country:US
Mailing Address - Phone:434-219-6394
Mailing Address - Fax:434-219-6394
Practice Address - Street 1:3500 POWHATAN ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6512
Practice Address - Country:US
Practice Address - Phone:434-219-6394
Practice Address - Fax:434-219-6394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care