Provider Demographics
NPI:1023537800
Name:SECONDCHANCE RECOVERY HOUSE LLC
Entity Type:Organization
Organization Name:SECONDCHANCE RECOVERY HOUSE LLC
Other - Org Name:REBIRTH ENHANCEMENT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LITRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-267-2844
Mailing Address - Street 1:1410 CRAIN HWY N STE 5B
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-9304
Mailing Address - Country:US
Mailing Address - Phone:443-267-2844
Mailing Address - Fax:866-450-9832
Practice Address - Street 1:1410 CRAIN HWY N STE 5B
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-9304
Practice Address - Country:US
Practice Address - Phone:443-267-2844
Practice Address - Fax:866-450-9832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care