NPIMap

Organization Active NPI

Second Chance Cabrillo Center

  • Community/Behavioral Health Agency
  • Freemont, CA
National Provider Identifier
1285837583
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
0193 Issued in 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
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mark R McConville
Title
Executive Director
Phone
(510) 792-4357

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 0193 CA Primary

Addresses

Primary practice location

4673 Thornton Avenue
Suite P
Freemont, CA 94536

Mailing address

Box 643
Newark, CA 94560
Phone (510) 792-4357

National Provider Directory

National Provider Directory
Tax ID family
Second Chance Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4673 Thornton Ave
Ste P
Fremont, CA 94536
Phone (510) 744-0674

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285837583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BOX 643",
            "city": "NEWARK",
            "state": "CA",
            "postal_code": "94560",
            "telephone_number": "510-792-4357",
            "fax_number": "510-745-1692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4673 THORNTON AVENUE",
            "address_2": "SUITE P",
            "city": "FREEMONT",
            "state": "CA",
            "postal_code": "94536",
            "telephone_number": "510-745-1675",
            "fax_number": "510-744-0674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND CHANCE CABRILLO CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCCONVILLE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "510-792-4357"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "0193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Freemont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.