Healthcare Provider Details

I. General information

NPI: 1891298279
Provider Name (Legal Business Name): SECOND CHANCE BEHAVIORAL HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5517 RITCHIE HWY STE A
BROOKLYN PARK MD
21225-3457
US

IV. Provider business mailing address

2754 PIEDMONT HOLW
FINKSBURG MD
21048-1830
US

V. Phone/Fax

Practice location:
  • Phone: 410-504-9048
  • Fax:
Mailing address:
  • Phone: 410-504-9048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. TOWANDA TAYLOR
Title or Position: DIRECTOR
Credential:
Phone: 410-504-9048