Healthcare Provider Details

I. General information

NPI: 1801606512
Provider Name (Legal Business Name): SECOND CHANCE TRANSITIONAL HOUSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 GORRELL ST
GREENSBORO NC
27406-1904
US

IV. Provider business mailing address

2774 WAYNE WHITE RD
PLEASANT GARDEN NC
27313-8157
US

V. Phone/Fax

Practice location:
  • Phone: 336-291-8333
  • Fax: 336-233-2234
Mailing address:
  • Phone: 336-547-0261
  • Fax: 336-233-2234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHANTINA HINTON
Title or Position: DIRECTOR
Credential: CLC, CPSS, CADC, LCA
Phone: 336-547-0261