2ND Chanzs

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

2ND CHANZS

Practice address

1214 E Jen Dr
Flagstaff, AZ 86001-0757

Phone

(623) 478-9400

NPI assigned

Jul 9, 2014

Last updated

Jul 9, 2014By the provider in NPPES

Organization subpart

Yes

Parent organization

SUCCESSFUL JOURNEYSAs reported in NPPES

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

Authorized official

Name

Mr. Sekou Jackson, MPA, CPM

Title

Executive Director

Phone

(623) 478-9400

Specialties & licenses 1

Addresses

Part of

Successful Journeys LLC

Locations

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

{
    "created_epoch": "1404864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1932515087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9950 W VAN BUREN ST",
            "address_2": "SUITE B135",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853235322",
            "telephone_number": "623-478-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1214 E JEN DR",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860010757",
            "telephone_number": "623-478-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "2ND CHANZS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUCCESSFUL JOURNEYS",
        "enumeration_date": "2014-07-09",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "SEKOU",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "623-478-9400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPA, CPM"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; 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.