Provider Demographics
NPI:1558806042
Name:SECOND CHANCE DETOX, LLC
Entity Type:Organization
Organization Name:SECOND CHANCE DETOX, LLC
Other - Org Name:PINES RECOVERY LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMAR
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:MARKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-505-5550
Mailing Address - Street 1:1190 HIBISCUS DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4554
Mailing Address - Country:US
Mailing Address - Phone:954-505-5550
Mailing Address - Fax:954-606-0248
Practice Address - Street 1:1151 POINCIANA DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4561
Practice Address - Country:US
Practice Address - Phone:954-505-5550
Practice Address - Fax:954-606-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility