Provider Demographics
NPI:1629857628
Name:2ND CHANCE HOMECARE SERVICES, LLC
Entity Type:Organization
Organization Name:2ND CHANCE HOMECARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OMA DOCETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-487-9481
Mailing Address - Street 1:7631 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5795
Mailing Address - Country:US
Mailing Address - Phone:219-487-9481
Mailing Address - Fax:219-203-4077
Practice Address - Street 1:7631 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5795
Practice Address - Country:US
Practice Address - Phone:219-487-9481
Practice Address - Fax:219-203-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health