MEDICARE: SECOND CHANCE ALF, 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	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1235085234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND CHANCE ALF, INC

Provider Business Mailing Address
First Line	:	3782 NW 202ND ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-1433
Country	:	US
Telephone Number	:	305-974-2091
Fax Number	:	786-396-5317

Provider Business Practice Location Address
First Line	:	3782 NW 202ND ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-1433
Country	:	US
Telephone Number	:	305-974-2091
Fax Number	:	786-396-5317

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ANNELIESSE SANTANA
Credential	:
Telephone Number	:	786-534-3457

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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