| Second Chance Recovery House Llc | |
|
1410 Crain Hwy N Ste 5b Glen Burnie MD 21061-9304 | |
| (410) 903-8710 | |
| Not Available |
| Full Name | Second Chance Recovery House Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1410 Crain Hwy N Ste 5b, Glen Burnie, Maryland |
| Authorized Official Name and Position | Litra Simms (CEO) |
| Authorized Official Contact | 4109038710 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Second Chance Recovery House Llc 1410 Crain Hwy N Ste 5b Glen Burnie MD 21061-9304 Ph: () - | Second Chance Recovery House Llc 1410 Crain Hwy N Ste 5b Glen Burnie MD 21061-9304 Ph: (410) 903-8710 |
| NPI Number | 1407588064 |
|---|---|
| Provider Enumeration Date | 06/30/2022 |
| Last Update Date | 06/30/2022 |
| Certification Date | 06/22/2022 |
| Medicare PECOS PAC ID | 3173970373 |
|---|---|
| Medicare Enrollment ID | O20231109001796 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407588064 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Uwaezu Mercy Kalu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558967653 PECOS PAC ID: 2860882750 Enrollment ID: I20211208002150 |
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