SECOND CHANCE PHOENIX MINISTRY, INC (NPI# 1487002317) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487002317 |
| Entity Type | Organization |
| Organization Name | SECOND CHANCE PHOENIX MINISTRY, INC |
| Other Organization Name | HEART TRANSFORMATION |
| Practice Address |
3218 Eagle Watch Dr Kissimmee FL 34746-3138 |
| Practice Telephone | 4079014000 |
| Practice Fax Number | 4079304830 |
| Mailing Telephone | 4079014000 |
| Mailing Fax Number | 4079304830 |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2016-06-02 |
| Authorized Official Name | DR. VICKKI-ANN S. SAMUEL (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 4079014000 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | CARF ACCREDITED | FL | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Heart Transformation | Doing Business As Name - Organization |
| Street Address |
3218 EAGLE WATCH DR |
| City | KISSIMMEE |
| State | FL |
| Zip Code | 34746-3138 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548730195 | Suma Joseph Kurian | Nurse Practitioner | Florida Lung Asthma Lung Specialists, 3480 Polynesian Isle Blvd, Kissimmee, FL 34746 | 2018-11-27 |
| 1538663240 | Terri Alexander Charlock | Specialist/Technologist | 5314 Barefoot Path, Kissimmee, FL 34746 | 2018-03-19 |
| 1811404452 | Debbie Camille Carvalho | Psychologist | 4449 Great Habor Lane, Kissimmee, FL 34746 | 2018-01-04 |
| 1679096390 | Sheyla Marie Vargas | Behavior Technician | 4118 Shelter Bay Dr, Kissimmee, FL 34746 | 2017-07-25 |
| 1013464601 | Falguni Patel | Pharmacist | 3298 S John Young Parkway, Kissimmee, FL 34746 | 2016-09-01 |
| 1942656004 | Kheira Liz Rodriguez | Case Manager/Care Coordinator | 198 London Dr, Kissimme, FL 34746 | 2016-05-09 |
| 1821456005 | Irma Valentin | Counselor | 4166 Key Colony Pl, Kissimmee, FL 34746 | 2016-02-03 |
| 1780050310 | Catherine M Alfieri | Physician Assistant | 119 Sunny Oak Trl, Kissimmee, FL 34746 | 2015-08-18 |
| 1396043956 | Mary Staffa | Speech-Language Pathologist | 2222 Granger Ave, Kissimmee, FL 34746 | 2011-03-07 |
| 1457661787 | Melita Cogburn | Counselor | 111 Monument Ave, Suite 509, Kissimmee, FL 34746 | 2010-10-20 |
| Find all providers in zip 34746 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427688852 | Tropical Gardens LLC | Community Based Residential Treatment Facility, Mental Illness | 150 Ne 212th St, Miami Gardens, FL 33179-1017 | 2020-01-24 |
| 1417505850 | Herve Franck | Community Based Residential Treatment Facility, Mental Illness | 13901 Folkestone Cir, Wellington, FL 33414-7825 | 2019-08-28 |
| 1568014868 | Hestia House of Florida, Inc. | Community Based Residential Treatment Facility, Mental Illness | 816 N Grandview Ave # 2, Daytona Beach, FL 32118-3721 | 2019-07-16 |
| 1336628155 | Lavoryia Timmons | Community Based Residential Treatment Facility, Mental Illness | 24940 Hyde Park Blvd, Land O Lakes, FL 34639-6306 | 2018-08-13 |
| 1003324534 | Donyell Jones | Community Based Residential Treatment Facility, Mental Illness | 6239 Edgewater Dr Ste V2, Orlando, FL 32810-4764 | 2018-01-18 |
| 1437672748 | Reasons for Change, LLC | Community Based Residential Treatment Facility, Mental Illness | 143 Silver Beach Road, Lake Park, FL 33403 | 2017-07-18 |
| 1316477029 | Cerrato Associates Incorporation | Community Based Residential Treatment Facility, Mental Illness | 755 Shady Oaks Dr Apt 310, Palm Coast, FL 32164-2578 | 2017-06-14 |
| 1356877047 | Samaritan Counseling Center | Community Based Residential Treatment Facility, Mental Illness | 101 Se 3rd Avenue, Fort Lauderdale, FL 33301 | 2017-05-02 |
| 1780119917 | Open Arm Housing and Care | Community Based Residential Treatment Facility, Mental Illness | 4031 Nw 91st Ters, Sunrise, FL 33351 | 2017-04-25 |
| 1124476064 | Parent Support, LLC | Community Based Residential Treatment Facility, Mental Illness | 146 Sunset View Dr., Davenport, FL 33896 | 2016-06-01 |
| Find all providers with the same taxonomy | ||||
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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.