Provider Demographics
NPI:1437683232
Name:SECOND CHANCE RESOURCES LLC
Entity type:Organization
Organization Name:SECOND CHANCE RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZEPHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-206-2328
Mailing Address - Street 1:5135 CAMINO AL NORTE
Mailing Address - Street 2:STE 255
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2387
Mailing Address - Country:US
Mailing Address - Phone:702-664-1258
Mailing Address - Fax:
Practice Address - Street 1:5135 CAMINO AL NORTE
Practice Address - Street 2:STE 255
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2387
Practice Address - Country:US
Practice Address - Phone:702-664-1258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20171249461251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health