NPIMap

Organization Active NPI

Second Chance Recovery House LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Glen Burnie, MD
National Provider Identifier
1407588064
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
SECOND CHANCE RECOVERY HOUSE LLC
Practice address
1410 Crain Hwy N Ste 5B
Glen Burnie, MD 21061-9304
Phone
(410) 903-8710
NPI assigned
Jun 30, 2022
Organization subpart
Yes
Parent organization
SECOND CHANCE RECOVERY HOUSE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Authorized official

Name
Litra Simms
Title
Ceo
Phone
(410) 903-8710

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1410 Crain Hwy N Ste 5B
Glen Burnie, MD 21061-9304

Mailing address

1410 Crain Hwy N Ste 5B
Glen Burnie, MD 21061-9304

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231109001796 MD Part B Supplier - Clinic/Group Practice 3173970373 Receives reassigned benefits from 3 practitioners
Practice locations: Glen Burnie, MD

National Provider Directory

National Provider Directory
Tax ID family
Secondchance Recovery House LLC6 organizations share this tax ID, including this one
Part of
Secondchance Recovery House LLC

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1656547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656547200000",
    "number": "1407588064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 CRAIN HWY N STE 5B",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210619304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 CRAIN HWY N STE 5B",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210619304",
            "telephone_number": "410-903-8710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND CHANCE RECOVERY HOUSE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SECOND CHANCE RECOVERY HOUSE LLC",
        "enumeration_date": "2022-06-30",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-22",
        "status": "A",
        "authorized_official_last_name": "SIMMS",
        "authorized_official_first_name": "LITRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-903-8710"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.