MEDICARE: SECOND CHANCE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	324500000X	Substance Abuse Rehabilitation Facility
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1447981477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND CHANCE SERVICES

Provider Business Mailing Address
First Line	:	756 TYVOLA RD STE 116
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-3535
Country	:	US
Telephone Number	:	646-270-2269
Fax Number	:

Provider Business Practice Location Address
First Line	:	756 TYVOLA RD STE 116
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-3535
Country	:	US
Telephone Number	:	646-270-2269
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALBERTO LESLIE
Credential	:
Telephone Number	:	646-270-2269

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	08/23/2024

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Directions to “SECOND CHANCE SERVICES ” Practice Location

Language	Start Address	Practice Location

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