MEDICARE: SECOND BEGINNINGS SUPPORT SERVICES, LLC

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	251B00000X	Case Management Agency		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558668467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND BEGINNINGS SUPPORT SERVICES, LLC

Provider Business Mailing Address
First Line	:	6712 ATLANTIC BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-8730
Country	:	US
Telephone Number	:	904-438-2558
Fax Number	:	904-438-2578

Provider Business Practice Location Address
First Line	:	6712 ATLANTIC BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-8730
Country	:	US
Telephone Number	:	904-438-2558
Fax Number	:	904-438-2578

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	YVONNE DUNCAN
Credential	:
Telephone Number	:	904-438-2577

Provider Enumeration Date	:	02/12/2011
Last Update Date	:	03/27/2012

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