SECOND GENESIS, INC. (NPI# 1427352681) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427352681 |
| Entity Type | Organization |
| Organization Name | SECOND GENESIS, INC. |
| Practice Address |
107 Circle Dr Crownsville MD 21032-2061 |
| Mailing Address |
8611 2nd Ave Suite 300 Silver Spring MD 20910-3372 |
| Practice Telephone | 3016219013 |
| Mailing Telephone | 3015631545 |
| Mailing Fax Number | 3015631546 |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2011-01-03 |
| Authorized Official Name | MR. MARK SEGAL (DIRECTOR OF CLINICAL OPERATIONS) |
| Authorized Official Telephone | 3015631545 |
| Authorized Official Credential | LCSW-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR0401X |
Clinic/Center Specialization: Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
904039 | MD | Ambulatory Health Care Facilities |
| N | 261Q00000X | Clinic/Center | 904039 | MD | Ambulatory Health Care Facilities |
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
904039 | MD | Ambulatory Health Care Facilities |
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 1053589242 | MD | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790766855 | Second Genesis, Inc. | Substance Abuse Rehabilitation Facility | 8611 2nd Ave, Suite 300, Silver Spring, MD 20910-3372 | 2005-11-07 |
| Street Address |
107 CIRCLE DR |
| City | CROWNSVILLE |
| State | MD |
| Zip Code | 21032-2061 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053589242 | Second Genesis, Inc | Substance Abuse Rehabilitation Facility | 107 Circle Dr, Tarditional, Crownsville, MD 21032-2061 | 2008-02-11 |
| 1558881417 | Gaudenzia Inc | Substance Abuse Rehabilitation Facility | 107 Circle Dr, Crownsville, MD 21032-2061 | 2017-06-22 |
| 1386164242 | Gaudenzia Inc | Clinic/Center | 107 Circle Dr, Crownsville, MD 21032-2061 | 2017-06-22 |
| 1750755351 | Gaudenzia, Inc. | Substance Abuse Rehabilitation Facility | 107 Circle Dr, Crownsville, MD 21032-2061 | 2015-11-19 |
| 1003084146 | Second Genesis, Inc | Substance Abuse Rehabilitation Facility | 107 Circle Dr, Co-occurring, Crownsville, MD 21032-2061 | 2008-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841498680 | Mary Elizabeth Bracken | Internal Medicine | 2015 Martins Grant Ct, Crownsville, MD 21032 | 2007-07-03 |
| 1225113061 | Addictions Recovery Inc | Rehabilitation, Substance Use Disorder Unit | 26 Marbury Rd, Crownsville, MD 21032 | 2006-10-26 |
| 1801809512 | Rodney A Floyd | Dentist | 1017 Generals Highway, Crownsville, MD 21032 | 2006-08-14 |
| 1053953372 | Indra Sidhu Dds | Clinic/Center | 208 Crain Hwy Sw, Glen Burnie, MD 21032 | 2019-10-09 |
| 1760995831 | Saundra Valera | Nurse Practitioner | 1454 Fairfield Loop Rd, Crownsville, MD 21032 | 2017-11-13 |
| 1871982611 | Addiction Recovery Inc | Counselor | 26 Marbury Dr, Crownsville, MD 21032 | 2015-01-16 |
| 1215290887 | Stephanie Ray | Occupational Therapist | 1454 Fairfield Loop Rd, Crownsville, MD 21032 | 2012-06-19 |
| 1861769499 | Michelle Marie Jones | Registered Nurse | 1122 Oak View Dr, Crownsville, MD 21032-1039 | 2011-11-28 |
| 1326518101 | Katherine Spohn Streett | Counselor | 1141 Sunrise Beach Rd, Crownsville, MD 21032-1126 | 2018-12-05 |
| 1598140865 | Guy Merritt Iv | Counselor | 813 Miner Rd, Crownsville, MD 21032-1203 | 2015-07-28 |
| Find all providers in zip 21032 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518514736 | Reconnect Recovery Services, LLC | Substance Abuse Rehabilitation Facility | 2010 Saint Stephens Woods Dr, Crownsville, MD 21032-2200 | 2019-08-22 |
| 1851767982 | The Landing At Serenity, LLC | Substance Abuse Rehabilitation Facility | 2007 Saint Stephens Woods Dr, Crownsville, MD 21032-2200 | 2015-08-12 |
| 1053589242 | Second Genesis, Inc | Substance Abuse Rehabilitation Facility | 107 Circle Dr, Tarditional, Crownsville, MD 21032-2061 | 2008-02-11 |
| 1942281423 | Chrysalis House Inc | Substance Abuse Rehabilitation Facility | 1570 Crownsville Rd, Crownsville, MD 21032-2306 | 2005-11-10 |
| 1558881417 | Gaudenzia Inc | Substance Abuse Rehabilitation Facility | 107 Circle Dr, Crownsville, MD 21032-2061 | 2017-06-22 |
| 1316477573 | Chrysalis House, Inc. | Substance Abuse Rehabilitation Facility | 1570 Crownsville Rd, Crownsville, MD 21032-2306 | 2017-06-19 |
| 1750755351 | Gaudenzia, Inc. | Substance Abuse Rehabilitation Facility | 107 Circle Dr, Crownsville, MD 21032-2061 | 2015-11-19 |
| 1083007215 | Addiction Recovery, Inc. | Substance Abuse Rehabilitation Facility | 26 Marbury Dr, Crownsville, MD 21032-2065 | 2015-03-12 |
| 1447682646 | Chrysalis House, Inc | Substance Abuse Rehabilitation Facility | 1570 Crownsville Rd, Crownsville, MD 21032-2306 | 2013-07-30 |
| 1730486275 | Serenity Acres Treatment Center LLC | Substance Abuse Rehabilitation Facility | 2015 Martins Grant Ct, Crownsville, MD 21032-1932 | 2011-02-18 |
| Find all providers in CROWNSVILLE | ||||
| City | CROWNSVILLE |
| Zip Code | 21032 |
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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.