Basic Information
| Provider Information | |||||||||
| NPI: | 1073122420 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SECOND CHANCES RECOVERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 COMEAUX RD | ||||||||
| Address2: | |||||||||
| City: | RAYVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183035500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 161 COMEAUX RD | ||||||||
| Address2: | |||||||||
| City: | RAYVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712697554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183035500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2020 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCEACHARN | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | RILEY | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3183035500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.