Provider Demographics
NPI:1851089395
Name:SECOND CHANCE II LLC
Entity Type:Organization
Organization Name:SECOND CHANCE II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:443-503-5096
Mailing Address - Street 1:3413 DUNDALK AVE
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-5921
Mailing Address - Country:US
Mailing Address - Phone:443-503-5096
Mailing Address - Fax:
Practice Address - Street 1:3413 DUNDALK AVE
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-5921
Practice Address - Country:US
Practice Address - Phone:443-503-5096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health