NPIMap

Organization Active NPI

2ND Chance Mental Health Center, LLC

  • Community/Behavioral Health Agency
  • Port Saint Lucie, FL
National Provider Identifier
1447554019
Registry record updated Dec 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
1956AD422201 Issued in FL
Legal business name
2ND CHANCE MENTAL HEALTH CENTER, LLC
Practice address
1250 SE Port St Lucie Blvd Ste C
Port Saint Lucie, FL 34952-5385
Phone
(772) 249-0880
Fax
(772) 249-0881
NPI assigned
Dec 22, 2010
Last updated
Dec 22, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2010

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

Authorized official

Name
Jean M Larsen, MSW
Title
President
Phone
(772) 249-0880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 1956AD422201 FL Primary

Addresses

Primary practice location

1250 SE Port St Lucie Blvd Ste C
Port Saint Lucie, FL 34952-5385

Mailing address

1250 SE Port St Lucie Blvd Ste C
Port Saint Lucie, FL 34952-5385
Phone (772) 249-0880

National Provider Directory

National Provider Directory
Tax ID family
2ND Chance Mental Health Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1250 SE Port St Lucie Blvd
Ste C
Port Saint Lucie, FL 34952
Phone (772) 249-0880

NPI Registry JSON

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

{
    "created_epoch": "1292976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292976000000",
    "number": "1447554019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 SE PORT ST LUCIE BLVD STE C",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349525385",
            "telephone_number": "772-249-0880",
            "fax_number": "772-249-0881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 SE PORT ST LUCIE BLVD STE C",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349525385",
            "telephone_number": "772-249-0880",
            "fax_number": "772-249-0881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "2ND CHANCE MENTAL HEALTH CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-22",
        "last_updated": "2010-12-22",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "772-249-0880",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "1956AD422201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Saint Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2010; 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.