Provider Demographics
NPI:1063152346
Name:SECOND CHANCE CASE MANAGEMENT INC
Entity type:Organization
Organization Name:SECOND CHANCE CASE MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNELIESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-302-5424
Mailing Address - Street 1:15485 EAGLE NEST LN STE 150
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2200
Mailing Address - Country:US
Mailing Address - Phone:178-302-5424
Mailing Address - Fax:786-396-5317
Practice Address - Street 1:15485 EAGLE NEST LN STE 150
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2200
Practice Address - Country:US
Practice Address - Phone:178-302-5424
Practice Address - Fax:786-396-5317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)