Second Chance of Northwest Florida

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

SECOND CHANCE OF NORTHWEST FLORIDA

Practice address

819 E 11TH St
Panama City, FL 32401-3459

Phone

(850) 769-7779

Fax

(850) 215-7718

NPI assigned

Jun 24, 2015

Last updated

Jun 24, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jon Cupp

Title

Director

Phone

(850) 769-7779

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435104000000",
    "number": "1114309333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 E 11TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324013459",
            "telephone_number": "850-769-7779",
            "fax_number": "850-215-7718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 E 11TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324013459",
            "telephone_number": "850-769-7779",
            "fax_number": "850-215-7718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND CHANCE OF NORTHWEST FLORIDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-24",
        "last_updated": "2015-06-24",
        "status": "A",
        "authorized_official_last_name": "CUPP",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "850-769-7779",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sea Oats Medical Clinic
• Debbie Carmella Seago
• Monica Seal, DPT
• Seaside Speech Services
• Seawind Medical Clinic LLC
• Corinne Marie Seemuth, LMT
• Select Specialty Hospital - Panama City Inc
• Deena G. Self, LMHC
• Kolton Wade Sellers, BCBA
• Samantha Sue Sellers, PA

• Developmentally Disabled Services Day Training Agency in Panama City, FL
• Providers in Panama City, FL by specialty
• Developmentally Disabled Services Day Training Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.