Second Chance Group Home Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

SECOND CHANCE GROUP HOME INC.

Practice address

4548 Powderhorn Place Dr
Clermont, FL 34711-8940

Phone

(352) 396-1247

Fax

(352) 394-2353

NPI assigned

Jan 26, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ricky Lamar Roberson

Title

Owner

Phone

(352) 396-1247

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643155200000",
    "number": "1245982677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4548 POWDERHORN PLACE DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347118940",
            "telephone_number": "352-396-1247",
            "fax_number": "352-394-2353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4548 POWDERHORN PLACE DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347118940",
            "telephone_number": "352-396-1247",
            "fax_number": "352-394-2353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND CHANCE GROUP HOME INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-26",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A",
        "authorized_official_last_name": "ROBERSON",
        "authorized_official_first_name": "RICKY",
        "authorized_official_middle_name": "LAMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-396-1247"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Clermont, FL
• Providers in Clermont, FL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.