NPIMap

Organization Active NPI

Second Chance Phoenix Ministry, Inc

Doing business as Heart Transformation

  • Mental Illness Community Based Residential Treatment Facility
  • Kissimmee, FL
National Provider Identifier
1487002317
Registry record updated Jun 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
CARF ACCREDITED Issued in FL
Legal business name
SECOND CHANCE PHOENIX MINISTRY, INC
Doing business as
Heart Transformation
Practice address
3218 Eagle Watch Dr
Kissimmee, FL 34746-3138
Phone
(407) 901-4000
Fax
(407) 930-4830
NPI assigned
Jun 1, 2016
Last updated
Jun 2, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2016

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

Authorized official

Name
Dr. Vickki-Ann S. Samuel, M.D.
Title
Medical Director
Phone
(407) 901-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X CARF ACCREDITED FL Primary

Addresses

Primary practice location

3218 Eagle Watch Dr
Kissimmee, FL 34746-3138

Mailing address

3218 Eagle Watch Dr
Kissimmee, FL 34746-3138
Phone (407) 901-4000

Other names 1

  • Heart Transformation Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cares Treatment6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1464739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464825600000",
    "number": "1487002317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3218 EAGLE WATCH DR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347463138",
            "telephone_number": "407-901-4000",
            "fax_number": "407-930-4830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3218 EAGLE WATCH DR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347463138",
            "telephone_number": "407-901-4000",
            "fax_number": "407-930-4830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND CHANCE PHOENIX MINISTRY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-01",
        "last_updated": "2016-06-02",
        "status": "A",
        "authorized_official_last_name": "SAMUEL",
        "authorized_official_first_name": "VICKKI-ANN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "407-901-4000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "FL",
            "license": "CARF ACCREDITED",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heart Transformation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kissimmee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2016; 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.