SECOND GENESIS, INC (NPI# 1316115454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316115454 |
| Entity Type | Organization |
| Organization Name | SECOND GENESIS, INC |
| Practice Address |
4620 Melwood Rd Upper Marlboro MD 20772-9507 |
| Mailing Address |
8611 2nd Ave Silver Spring MD 20910-3372 |
| Practice Telephone | 3015631545 |
| Practice Fax Number | 3015631546 |
| Mailing Telephone | 3015631545 |
| Mailing Fax Number | 3015631546 |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2008-02-12 |
| Authorized Official Name | MR. J MICHAEL MCGUINNESS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3015631545 |
| Authorized Official Credential | MSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
903298 | MD | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053589242 | Second Genesis, Inc | Substance Abuse Rehabilitation Facility | 107 Circle Dr, Tarditional, Crownsville, MD 21032-2061 | 2008-02-11 |
| 1003084146 | Second Genesis, Inc | Substance Abuse Rehabilitation Facility | 107 Circle Dr, Co-occurring, Crownsville, MD 21032-2061 | 2008-02-12 |
| Street Address |
4620 MELWOOD RD |
| City | UPPER MARLBORO |
| State | MD |
| Zip Code | 20772-9507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497355077 | Doris Lynn Perkins | Pharmacist | 5700 Southeast Crain Hwy, Upper Marlboro, MD 20772 | 2020-10-31 |
| 1730790221 | Creative Mind Therapy | Community/Behavioral Health | 12419 Dorsey Ln, Upper Marlboro, MD 20772 | 2020-08-10 |
| 1932727369 | Shaquitta Morton | Behavior Technician | 9440 Marlboro Pike 100, Upper Marlboro, MD 20772 | 2020-07-13 |
| 1760022958 | Keri Daniel | Nurse Practitioner | 9723 Frank Tippett Rd, Upper Marlboro, MD 20772 | 2020-01-15 |
| 1932668134 | Dentistry for Children of Maryland, LLC | Clinic/Center | 9616 Marlboro Pike, Upper Marlboro, MD 20772 | 2019-03-18 |
| 1033673918 | Shonte Renee Drakeford | Nurse Practitioner | 6610 Woodyard Road, Upper Marlboro, MD 20772 | 2019-01-25 |
| 1902391261 | Myenne Hanson | Home Health Aide | 5002 Ashford Dr, Upper Marlboro, MD 20772 | 2018-06-28 |
| 1659884849 | Clement Okehie | Home Health Aide | 13939 Bishops Bequest Rd, Upper Marlboro, MD 20772 | 2017-11-09 |
| 1497264766 | Fatu Barrie | Technician | 11112 Cranfod Drive, Upper Marlboro, MD 20772 | 2017-09-29 |
| 1801315080 | Hope Academy & Nursing Services | Nursing Care | 14101 Christian Street, Upper Marlboro, MD 20772 | 2017-09-19 |
| Find all providers in zip 20772 | ||||
| Taxonomy Code | 3245S0500X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| Specialization | Substance Abuse Treatment, Children |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821697640 | Peaceful Minds Residential Services | Substance Abuse Rehabilitation Facility | 3704 S Hanover St, Baltimore, MD 21225-1773 | 2020-10-22 |
| 1215548573 | Peaceful Minds Residential Services | Substance Abuse Rehabilitation Facility | 3704 S Hanover St Unit 2a2b, Baltimore, MD 21225-1773 | 2020-08-11 |
| 1093332595 | A Brighter Day Behavioral Health Center | Substance Abuse Rehabilitation Facility | 8350 Bristol Ct Ste 101, Jessup, MD 20794-9756 | 2020-06-30 |
| 1497316715 | Center for Creative Values, Inc | Substance Abuse Rehabilitation Facility | 8110 Harford Road, Suite B, Parkville, MD 21234-2123 | 2019-06-26 |
| 1255875753 | Contemporary Family Services, Inc | Substance Abuse Rehabilitation Facility | 6525 Belcrest Rd., G40, Hyattsville, MD 20782-2003 | 2016-12-19 |
| 1356694277 | One World Foundation | Substance Abuse Rehabilitation Facility | 807 Balsamtree Dr, Capitol Heights, MD 20743-1427 | 2012-10-16 |
| 1932334406 | Victor Cullen Center | Substance Abuse Rehabilitation Facility | 6000 Cullen Dr, Sabillasville, MD 21780-9701 | 2009-05-27 |
| 1538355524 | Meadow Mountain Drug Treatment Program | Substance Abuse Rehabilitation Facility | 234 Recovery Rd, Grantsville, MD 21536-2217 | 2007-09-24 |
| 1124223979 | Collington Square Non Profit Corporation | Substance Abuse Rehabilitation Facility | 1211 N Chester St, Baltimore, MD 21213-3330 | 2007-06-20 |
| 1316546823 | Peaceful Minds Residential Services | Substance Abuse Rehabilitation Facility | 3704 S Hanover St, Baltimore, MD 21225-1773 | 2020-10-26 |
| Find all providers with the same taxonomy | ||||
| City | UPPER MARLBORO |
| Zip Code | 20772 |
Please comment or provide details below to improve the information on SECOND GENESIS, INC.
| 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.