# SECOND CHANCE HEALTHCARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548099765
- **Authorized official:** CHAKITA LAVETT BEVERLY AGPCNP-C, PMHNP-BC (NURSE PRACTITIONER/OWNER)
- **Authorized official phone:** (662) 374-3209

## Contact information

- **Practice address:** 405 RIVER RD, GREENWOOD, MS 38930-4212
- **Practice address phone:** (662) 304-8805
- **Practice address fax:** (662) 362-8061
- **Mailing address:** 1101 MISSISSIPPI AVE, GREENWOOD, MS 38930-5224
- **Mailing address phone:** (662) 374-3209

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/27/2024
- **Last updated:** 08/13/2024