Provider Demographics
NPI:1558108670
Name:MEN'S SECOND CHANCE LIVING
Entity type:Organization
Organization Name:MEN'S SECOND CHANCE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILANDER
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:208-481-0182
Mailing Address - Street 1:PO BOX 2398
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-2398
Mailing Address - Country:US
Mailing Address - Phone:208-481-0182
Mailing Address - Fax:
Practice Address - Street 1:400 S MAIN ST STE 304B
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8875
Practice Address - Country:US
Practice Address - Phone:208-481-1018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health