| Southeast Second Chance, Inc | |
|
600 G St Ste 6 Brunswick GA 31520-6727 | |
| (912) 265-2055 | |
| (912) 265-2509 |
| Full Name | Southeast Second Chance, Inc |
|---|---|
| Speciality | Social Worker |
| Location | 600 G St Ste 6, Brunswick, Georgia |
| Authorized Official Name and Position | Stephanie Cruwys (OWNER) |
| Authorized Official Contact | 9122652055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Second Chance, Inc Po Box 2727 Brunswick GA 31521-2727 Ph: (912) 265-2055 | Southeast Second Chance, Inc 600 G St Ste 6 Brunswick GA 31520-6727 Ph: (912) 265-2055 |
| NPI Number | 1932223302 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 02/06/2023 |
| Certification Date | 02/06/2023 |
| Medicare PECOS PAC ID | 7012000557 |
|---|---|
| Medicare Enrollment ID | O20070829000668 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932223302 | NPI | - | NPPES |
| 851663137A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW003287 (Georgia) | Primary |
| Provider Name | Stephanie Cruwys |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841302247 PECOS PAC ID: 4981680725 Enrollment ID: I20040629000513 |
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