Provider Demographics
NPI:1992412456
Name:SECOND CHANCE CASE MANAGEMENT LLC
Entity type:Organization
Organization Name:SECOND CHANCE CASE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HADDON
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-791-8070
Mailing Address - Street 1:400 PHARR RD NE UNIT 729
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2071
Mailing Address - Country:US
Mailing Address - Phone:404-806-0059
Mailing Address - Fax:404-400-5431
Practice Address - Street 1:400 PHARR RD NE UNIT 729
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2071
Practice Address - Country:US
Practice Address - Phone:404-806-0059
Practice Address - Fax:404-400-5431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management