MEDICARE: SECOND CHANCE CASE MANAGEMENT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1174383095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND CHANCE CASE MANAGEMENT INC

Provider Business Mailing Address
First Line	:	7614 NW 186TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2929
Country	:	US
Telephone Number	:	786-534-3457
Fax Number	:	786-396-5317

Provider Business Practice Location Address
First Line	:	7614 NW 186TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2929
Country	:	US
Telephone Number	:	786-534-3457
Fax Number	:	786-396-5317

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANNELIESSE SANTANA HERNANDEZ
Credential	:
Telephone Number	:	786-302-5224

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	09/11/2025

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