Provider Demographics
NPI:1558668467
Name:SECOND BEGINNINGS SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:SECOND BEGINNINGS SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-438-2577
Mailing Address - Street 1:6712 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-8730
Mailing Address - Country:US
Mailing Address - Phone:904-438-2558
Mailing Address - Fax:904-438-2578
Practice Address - Street 1:6712 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-8730
Practice Address - Country:US
Practice Address - Phone:904-438-2558
Practice Address - Fax:904-438-2578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-12
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142632096Medicaid
FL142632098Medicaid
FL003016600Medicaid