SECOND CHANCE SUPPORT SERVICES LLC (NPI# 1376169300) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376169300 |
| Entity Type | Organization |
| Organization Name | SECOND CHANCE SUPPORT SERVICES LLC |
| Practice Address |
741 Irwin St Anchorage AK 99508-1252 |
| Mailing Address |
7203 Foxridge Cir Unit 2 Anchorage AK 99518-2702 |
| Practice Telephone | 9076237432 |
| Mailing Telephone | 9076020146 |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2020-06-25 |
| Authorized Official Name | MOLUA SMITH BECKE (ADMINISTRATOR) |
| Authorized Official Telephone | 9076020146 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Second Chance Support Services LLC | Former Legal Business Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4924 Klondike Ave Spc 99, Anchorage, AK 995082414 | 9073341029 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245795269 | Second Chance Support Services LLC | Community/Behavioral Health | 22 E Church St Ste 319, Martinsville, VA 24112-6208 | 2019-02-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Second Chance Support Services LLC | 1513 Idlewild Blvd, Fredericksburg, Virginia 22401 |
| Street Address |
741 IRWIN ST |
| City | ANCHORAGE |
| State | AK |
| Zip Code | 99508-1252 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366063349 | Alexandra L Davis | Student in an Organized Health Care Education/Training Program | 1202 E 36th Ave, Anchorage, AK 99508 | 2020-05-01 |
| 1366087108 | The Salvation Army, A California Corporation | Community/Behavioral Health | 3600 East 20th Avenue, Anchorage, AK 99508 | 2019-11-15 |
| 1679120349 | Kila Gilcart | Speech-Language Pathologist | 161 Klevin Street #103, Anchorage, AK 99508 | 2019-08-19 |
| 1326692963 | Shannon Maillet | Behavior Technician | 1650 S Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1427602044 | Frank Harris Lawson Iv | Behavior Technician | 1650 S. Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1104470723 | Vivalesi Seforosa Nair | Behavior Technician | 1650 South Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1043864267 | The Cozy Chalet Assisted Living Home LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3707 Mt Blanc Circle, Anchorage, AK 99508 | 2019-07-25 |
| 1942861778 | Christine Mary Hoover | Registered Nurse | Alaska Native Medical Center - Inpatient Pediatrics, 4315 Diplomacy Dr, Anchorage, AK 99508 | 2019-06-24 |
| 1215594502 | Ashley Ongtowasruk | Case Manager/Care Coordinator | 4441 Dipomacy Dr, Suite 500, Anchorage, AK 99508 | 2019-05-22 |
| 1659937019 | Rayne Johnson | Behavior Technician | 4000 San Ernesto Blvd, Anchorage, AK 99508 | 2019-05-11 |
| Find all providers in zip 99508 | ||||
| Taxonomy Code | 3104A0625X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Mental Illness |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841815321 | Crisalyn Buenarte Ruiz | Assisted Living Facility | 3541 Corona Cir, Anchorage, AK 99517-1486 | 2020-06-10 |
| 1942858782 | My Home LLC | Assisted Living Facility | 6865 Viburnum Dr, Anchorage, AK 99507-2467 | 2019-08-26 |
| 1750935433 | Mind and Soul Assisted Living, LLC | Assisted Living Facility | 6124 E 12th Ave # D2, Anchorage, AK 99504-2355 | 2019-07-30 |
| 1689131989 | Tara Walker | Assisted Living Facility | 7774 Cherrywood Cir, Anchorage, AK 99507-2973 | 2019-02-23 |
| 1902381940 | Alkamba Marenah Enterprises, LLC | Assisted Living Facility | 1545 Demeure Pl, Anchorage, AK 99508-3164 | 2018-09-25 |
| 1629585229 | Jessica Tiara Fulton | Assisted Living Facility | 1001 Cherry St Unit A, Anchorage, AK 99504-2230 | 2018-01-04 |
| 1881109767 | Michael Anthony Brown | Assisted Living Facility | 7940 Little Dipper Ave, Anchorage, AK 99504-4125 | 2017-12-13 |
| 1740706548 | Susan Taylor-mclaughlin | Assisted Living Facility | 9113 Jewel Terrace St, Anchorage, AK 99502-5149 | 2017-08-15 |
| 1609309954 | Rowena R Jones | Assisted Living Facility | 4009 Scenic View, Anchorage, AK 99504 | 2017-04-04 |
| 1477946366 | Merlina Ganigan Duggan | Assisted Living Facility | 243 Klevin Street, Anchorage, AK 99508 | 2015-03-17 |
| Find all providers in ANCHORAGE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.