MEDICARE: SECOND CHANCE GROUP HOMES 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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1659223485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND CHANCE GROUP HOMES LLC

Provider Business Mailing Address
First Line	:	1509 HARRILL ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-2846
Country	:	US
Telephone Number	:	202-904-9325
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 HARRILL ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-2846
Country	:	US
Telephone Number	:	202-904-9325
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. BRYAN BROWN
Credential	:
Telephone Number	:	202-904-9325

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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