NPIMap

Organization Active NPI

Second Chance Ashland Center

  • Community/Behavioral Health Agency
  • San Leandro, CA
National Provider Identifier
1821290537
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
0119 Issued in CA
Legal business name
SECOND CHANCE ASHLAND CENTER
Practice address
1403 164TH Ave
San Leandro, CA 94578-3123
Phone
(510) 481-8645
Fax
(510) 481-2413
NPI assigned
Jun 4, 2007
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 0119 CA Primary

Addresses

Primary practice location

1403 164TH Ave
San Leandro, CA 94578-3123

Mailing address

1403 164TH Ave
San Leandro, CA 94578-3123
Phone (510) 481-8645

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

1403 164th Ave
Ashland, CA 94578
Phone (510) 276-7884

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821290537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1403 164TH AVE",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945783123",
            "telephone_number": "510-481-8645",
            "fax_number": "510-481-2413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1403 164TH AVE",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945783123",
            "telephone_number": "510-481-8645",
            "fax_number": "510-481-2413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND CHANCE ASHLAND CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "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": "0119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Leandro, 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.