Healthcare Provider Details

I. General information

NPI: 1235085234
Provider Name (Legal Business Name): SECOND CHANCE ALF, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3782 NW 202ND ST
MIAMI GARDENS FL
33055-1433
US

IV. Provider business mailing address

3782 NW 202ND ST
MIAMI GARDENS FL
33055-1433
US

V. Phone/Fax

Practice location:
  • Phone: 305-974-2091
  • Fax: 786-396-5317
Mailing address:
  • Phone: 305-974-2091
  • Fax: 786-396-5317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ANNELIESSE SANTANA
Title or Position: ADMINISTRATOR
Credential:
Phone: 786-534-3457