Provider Demographics
NPI:1629602164
Name:SECOND CHANCE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:SECOND CHANCE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:REE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-263-7245
Mailing Address - Street 1:25 WOODS LAKE RD STE 305
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2762
Mailing Address - Country:US
Mailing Address - Phone:864-263-7245
Mailing Address - Fax:864-263-7245
Practice Address - Street 1:25 WOODS LAKE RD STE 305
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2762
Practice Address - Country:US
Practice Address - Phone:864-263-7245
Practice Address - Fax:864-263-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCIHCP-1171OtherDHEC