Organization
SECOND CHANCE OF NORTHWEST FLORIDA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON CUPP (DIRECTOR)
(850) 769-7779
Entity
Organization
Contact information
Practice address
819 E 11TH ST, PANAMA CITY, FL 32401-3459
(850) 769-7779
(850) 215-7718
Mailing address
819 E 11TH ST, PANAMA CITY, FL 32401-3459
(850) 769-7779
(850) 215-7718
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
06/24/2015
Last updated
06/24/2015
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