| 2nd Chance Treatment Centers Llc | |
|
16620 N 40th St Ste E-1 Phoenix AZ 85032-3348 | |
| (602) 464-9576 | |
| (602) 626-8901 |
| Full Name | 2nd Chance Treatment Centers Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 16620 N 40th St Ste E-1, Phoenix, Arizona |
| Authorized Official Name and Position | David Andrew Sack (MEDICAL DIRECTOR) |
| Authorized Official Contact | 5629653193 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 2nd Chance Treatment Centers Llc 16620 N 40th St Ste E1 Phoenix AZ 85032-3357 Ph: (602) 464-5762 | 2nd Chance Treatment Centers Llc 16620 N 40th St Ste E-1 Phoenix AZ 85032-3348 Ph: (602) 464-9576 |
| NPI Number | 1780098228 |
|---|---|
| Provider Enumeration Date | 06/12/2014 |
| Last Update Date | 07/01/2024 |
| Certification Date | 07/01/2024 |
| Medicare PECOS PAC ID | 6406178243 |
|---|---|
| Medicare Enrollment ID | O20141204001738 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780098228 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0802X | Psychiatry & Neurology - Addiction Psychiatry | 48835 (Arizona) | Primary |
| Provider Name | Paul C Boulware |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609912146 PECOS PAC ID: 9335291558 Enrollment ID: I20090720000410 |
| Provider Name | Curtis Andrews |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659808103 PECOS PAC ID: 4385912831 Enrollment ID: I20170626000202 |
| Provider Name | Jennifer J Peterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427510437 PECOS PAC ID: 9537402128 Enrollment ID: I20190522003163 |
| Provider Name | Michael Francis Lavarnway |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700859493 PECOS PAC ID: 7911967203 Enrollment ID: I20201216001762 |
| Provider Name | Engelbert Marrero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457648107 PECOS PAC ID: 0143636605 Enrollment ID: I20210308001329 |
| Provider Name | Robert Rymowicz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760935746 PECOS PAC ID: 4385054949 Enrollment ID: I20210721003519 |
| Provider Name | Jared Brink |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306417258 PECOS PAC ID: 6709276611 Enrollment ID: I20211208003376 |
| Provider Name | Rebecca Anne Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003405739 PECOS PAC ID: 8426449075 Enrollment ID: I20211215002679 |
| Provider Name | Christian Gerwe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245734375 PECOS PAC ID: 3476985268 Enrollment ID: I20220531001568 |
| Provider Name | Fernando P Grabner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104321389 PECOS PAC ID: 9335481670 Enrollment ID: I20220613000503 |
| Provider Name | Robert M Wallen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609583517 PECOS PAC ID: 1153792643 Enrollment ID: I20230119002895 |
| Provider Name | David A Sack |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467657882 PECOS PAC ID: 8628478252 Enrollment ID: I20230413002022 |
| Provider Name | Caleb Lichtenberger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194415695 PECOS PAC ID: 4981061454 Enrollment ID: I20230530000939 |
| Provider Name | Yuvia Janine Herrera Espinoza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396420279 PECOS PAC ID: 5991167801 Enrollment ID: I20230809002033 |
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