Second Chance Cabrillo Center
Organization Active NPI Community/Behavioral Health Agency · Freemont, CA
NPI 1285837583 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1285837583
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- License
- 0193 (CA)
- Legal business name
- SECOND CHANCE CABRILLO CENTER
- Practice address
- 4673 Thornton Avenue
Suite P
Freemont, CA 94536 - Phone
- (510) 745-1675
- Fax
- (510) 744-0674
- NPI assigned
- Jun 6, 2007
- Organization subpart
- No
Authorized official
- Name
- Mark R McConville
- Title
- Executive Director
- Phone
- (510) 792-4357
Corporate family (same tax ID) 7
Practitioners 12
National Provider Directory
- Tax ID family
- Second Chance Inc
Locations
4673 Thornton Ave
Ste P
Fremont, CA 94536
Phone (510) 744-0674
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 0193 | CA | Yes |
Addresses
Primary practice location
4673 Thornton Avenue
Suite P
Freemont, CA 94536
Mailing address
Box 643
Newark, CA 94560
Phone (510) 792-4357
Other providers in Freemont, CA
All providers in Freemont, CA · Community/Behavioral Health Agency in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.