NPIMap

Organization Active NPI

Lifes Second Chance Treatment Center Lakisha Henderson Nelson Sole MBR

  • Methadone Clinic
  • Dallas, TX
National Provider Identifier
1821419201
Registry record updated May 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
License
1000045 Issued in TX
Legal business name
LIFES SECOND CHANCE TREATMENT CENTER LAKISHA HENDERSON NELSON SOLE MBR
Practice address
2615 S Lancaster Rd
Dallas, TX 75216-3112
Phone
(214) 376-7388
NPI assigned
Jan 2, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2020

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

Authorized official

Name
Lakisha HendersonNPI 1043651367
Title
Owner
Phone
(469) 360-6794

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X 1000045 TX Primary

Addresses

Primary practice location

2615 S Lancaster Rd
Dallas, TX 75216-3112

Mailing address

2615 S Lancaster Rd
Dallas, TX 75216-3112

Other identifiers 1

IdentifierTypeStateIssuer
1000045OtherTXPERMIT

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL lifessecondchance01@gmail.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Opioid treatment program
Medicare-enrolled since Mar 13, 2026

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200811001310 TX Part B Supplier - Opioid Treatment Program (Otp) 2163847948 Practice locations: Dallas, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1388620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590710400000",
    "number": "1821419201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 S LANCASTER RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752163112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 S LANCASTER RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752163112",
            "telephone_number": "214-376-7388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFES SECOND CHANCE TREATMENT CENTER LAKISHA HENDERSON NELSON SOLE MBR",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-02",
        "last_updated": "2020-05-29",
        "certification_date": "2020-05-29",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "LAKISHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "469-360-6794"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "TX",
            "license": "1000045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERMIT",
            "identifier": "1000045",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "lifessecondchance01@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2615 S Lancaster Rd",
            "city": "Dallas",
            "state": "TX",
            "country_code": "US",
            "postal_code": "752163112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.