MEDICARE: 2ND HOME COMMUNITY LIVING, 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	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1689524076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2ND HOME COMMUNITY LIVING, LLC

Provider Business Mailing Address
First Line	:	3131 S VAUGHN WAY STE 600
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80014-3508
Country	:	US
Telephone Number	:	303-999-7763
Fax Number	:

Provider Business Practice Location Address
First Line	:	7415 E 41ST AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80216-4707
Country	:	US
Telephone Number	:	303-999-7763
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HANEEN OMAR
Credential	:
Telephone Number	:	303-999-7763

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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