Second Chance Habilitation Services LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SECOND CHANCE HABILITATION SERVICES LLC

Practice address

2206 Emerywood Rd
Greensboro, NC 27403-3765

Phone

(336) 763-9718

NPI assigned

Jun 6, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Carlton Bullock

Title

Ceo

Phone

(252) 767-7624

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1591401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591401600000",
    "number": "1770107609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2206 EMERYWOOD RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274033765",
            "telephone_number": "336-763-9718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2206 EMERYWOOD RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274033765",
            "telephone_number": "336-763-9718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND CHANCE HABILITATION SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-06",
        "last_updated": "2020-06-06",
        "certification_date": "2020-06-06",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "CARLTON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "252-767-7624",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "2ndchancegso@gmail.com",
            "affiliation": "N",
            "address_1": "2206 Emerywood Rd",
            "city": "Greensboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "274033765",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.