MEDICARE: SECOND BEGINNINGS ALF

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)	AL11103	FL

General Provider Information

NPI Number	:	1447567540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND BEGINNINGS ALF

Provider Business Mailing Address
First Line	:	7306 MAPLE TREE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-2806
Country	:	US
Telephone Number	:	904-743-8283
Fax Number	:	904-743-0747

Provider Business Practice Location Address
First Line	:	7306 MAPLE TREE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-2806
Country	:	US
Telephone Number	:	904-743-8283
Fax Number	:	904-743-0747

Authorized Official
Title or Position	:	PRESIDENT/ ADMINISTRATOR
Name	:	YVONNE DUNCAN
Credential	:
Telephone Number	:	904-743-8283

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	09/10/2010

Similar Medicare Providers

1881987402 — TARA NICOLE DUNCAN
Practice Location Address:

7306 MAPLE TREE DR
JACKSONVILLE, FL
32277-2806

Practice Phone: 904-743-8283
Practice Fax: 904-743-0747

1477812584 — CHARLTON EDWIN BELL
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Practice Location Address:

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1578421053 — R.O.B. THE FOUNDATION
Practice Location Address:

7707 MERRILL RD UNIT 8309
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32277

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Practice Fax:

1538160007 — MRS. PENEMARIE KALLAS MURPHY PT
Practice Location Address:

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1144222696 — DR. ELAINE G HOLMES M.D.
Practice Location Address:

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Directions to “SECOND BEGINNINGS ALF ” Practice Location

Language	Start Address	Practice Location

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