SECOND CHANCE TRI-CITIES CENTER (NPI# 1336341098) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336341098 |
| Entity Type | Organization |
| Organization Name | SECOND CHANCE TRI-CITIES CENTER |
| Practice Address |
6330 Thornton Ave Newark CA 94560-3734 |
| Mailing Address |
Po Box 643 Newark CA 94560-0643 |
| Practice Telephone | 5107924357 |
| Practice Fax Number | 5107451693 |
| Mailing Telephone | 5107924357 |
| Mailing Fax Number | 5107451693 |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MARK R MCCONVILLE (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 5107924357 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | 0179 | CA | Agencies |
| Street Address |
6330 THORNTON AVE |
| City | NEWARK |
| State | CA |
| Zip Code | 94560-3734 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649481953 | Martin Montemayor | Counselor | 6330 Thornton Ave, Newark, CA 94560-3734 | 2007-05-25 |
| 1205473659 | Selena Wright | Counselor | 6330 Thornton Ave, Newark, CA 94560-3734 | 2019-12-04 |
| 1013567171 | Jeanette Makahilahila Ahkoi | Counselor | 6330 Thornton Ave, Newark, CA 94560-3734 | 2019-09-19 |
| 1063066025 | Terri Michelle Lewis | Counselor | 6330 Thornton Ave, Newark, CA 94560-3734 | 2019-07-29 |
| 1053973206 | Michael Lee Chidester Jr. | Counselor | 6330 Thornton Ave, Newark, CA 94560-3734 | 2019-07-08 |
| 1801394754 | Denise Soto | Counselor | 6330 Thornton Ave, Newark, CA 94560-3734 | 2018-01-25 |
| 1154840783 | Bradford Mitchell | Counselor | 6330 Thornton Ave, Newark, CA 94560 | 2017-09-14 |
| 1174063150 | Michael Daniloff | Counselor | 6330 Thornton Ave, Newark, CA 94560-3734 | 2017-02-24 |
| 1629511936 | Janel Cordova | Counselor | 6330 Thornton Ave, Newark, CA 94560-3734 | 2016-11-18 |
| 1407302979 | Kenynattah Hill | Counselor | 6330 Thornton Ave, Newark, CA 94560-3734 | 2016-08-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538713086 | Newark Square Dental Care Inc | Dentist | 5678 Thornton Ave., Newark, CA 94560 | 2019-08-01 |
| 1942788971 | Evelyn Ibanez | Behavioral Analyst | 35201 Lido Blvd, Newark, CA 94560 | 2018-08-01 |
| 1851892954 | Chito Pascual | Nurse Practitioner | 7600 Gateway Blvd., Newark, CA 94560 | 2018-02-23 |
| 1700295466 | Juan Emanuel Tan Santos | Dentist | 5270 Newpark Mall Road, Newark, CA 94560 | 2014-08-07 |
| 1063761146 | Sarah Larae Devoe Scribner | Physical Therapist | 5600 John Muir Road, Newark, CA 94560 | 2012-09-05 |
| 1285983858 | Louie Crespo Ortiz-luis | General Practice | 35455 Dumbarton Court, Newark, CA 94560 | 2012-08-29 |
| 1184932535 | Annie Thanh-yen Du | Psychologist | 3900 Newpark Mall Rd, Ste 300, Newark, CA 94560 | 2010-09-20 |
| 1083931836 | Susan Elizabeth Hanaburgh | Marriage & Family Therapist | 39899 Balentine Drive #212, Family Service of The Tri-cities, Newark, CA 94560 | 2010-05-03 |
| 1306098694 | Maria Isabelle Santos Tuohy | Dentist | 5270 Newpark Plaza, Newark, CA 94560 | 2008-10-17 |
| 1699955765 | Jaspreet Kaur Harika | Dentist | 39736 Cedar Blvd, Newark, CA 94560 | 2007-11-06 |
| Find all providers in zip 94560 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609493097 | Cognitive Organics LLC | Community/Behavioral Health | 14 N Park Pl, Newark, OH 43055-5517 | 2020-07-01 |
| 1861023889 | Neighbours-inc | Community/Behavioral Health | 286 Muhammad Ali Ave, Newark, NJ 07108-2016 | 2020-01-29 |
| 1538721824 | Robyn Hope Pavlick | Community/Behavioral Health | 183 S Orange Ave # Leveld, Newark, NJ 07103-2757 | 2019-07-08 |
| 1457910515 | Trdiann J Clement | Community/Behavioral Health | 288 Fairmount Ave, Newark, NJ 07103-2334 | 2019-06-11 |
| 1497224638 | Home Care for You, Inc. | Community/Behavioral Health | 1 Bloomfield Ave Ste 2, Newark, NJ 07104-2547 | 2018-11-16 |
| 1982195400 | Amari Behavioral Health | Community/Behavioral Health | 39 Maiden Ln, Newark, NJ 07102-5800 | 2018-05-21 |
| 1063901015 | Walloflions | Community/Behavioral Health | 402 Mount Prospect Ave Apt 11g, Newark, NJ 07104-2152 | 2018-05-04 |
| 1811485543 | Integrity, Inc. | Community/Behavioral Health | 103 Lincoln Park, Newark, NJ 07102-2388 | 2018-04-27 |
| 1023527496 | Youth Advocate Programs, Inc. | Community/Behavioral Health | 45 Academy St Ste 303, Newark, NJ 07102-2900 | 2017-09-28 |
| 1912424789 | Sandra Lou Fraley | Community/Behavioral Health | 15 North 3rd Street, Suite 300, Newark, OH 43055 | 2017-08-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.