MEDICARE: SECOND CHANCE SERVICES UNLIMITED, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1275744120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND CHANCE SERVICES UNLIMITED, INC.

Provider Business Mailing Address
First Line	:	3603 SETH COURT
Second Line	:
City	:	SPRINGDALE
State	:	MD
Zip	:	20774
Country	:	US
Telephone Number	:	301-386-6066
Fax Number	:	301-386-7787

Provider Business Practice Location Address
First Line	:	3603 SETH COURT
Second Line	:
City	:	SPRINGDALE
State	:	MD
Zip	:	20774
Country	:	US
Telephone Number	:	301-386-6066
Fax Number	:	301-386-7787

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DARREN L. PURNELL
Credential	:
Telephone Number	:	301-386-6066

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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