SECOND GENESIS (NPI# 1740439603) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740439603 |
| Entity Type | Organization |
| Organization Name | SECOND GENESIS |
| Practice Address |
4017 Minnesota Ave Ne Washington DC 20019-3541 |
| Mailing Address |
8611 2nd Ave Suite 300 Silver Spring MD 20910-3372 |
| Practice Telephone | 2023888570 |
| Practice Fax Number | 2023883523 |
| Mailing Telephone | 3015631545 |
| Mailing Fax Number | 3015631546 |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2008-09-16 |
| Authorized Official Name | MR. J. MICHAEL MCGUINNESS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3015631545 |
| Authorized Official Credential | M.S.W. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
111507A-171 | DC | Ambulatory Health Care Facilities |
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
111507A-Y-170 | DC | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 1316115454 | 05 | |
| DC | 1790766855 | 05 | |
| MD | 1003084146 | 05 | |
| MD | 1053589242 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | SECOND GENESIS INC. | 8120 Woodmont Avenue, Ste 400, Bethesda, Maryland 20814 |
| Virginia Business Entities | Second Genesis LLC | 8022 Provincetown, N. Chesterfield, Virginia 23235 |
| Oregon Corporations, Companies and Business Names | SECOND GENESIS, LTD. | 5860 Ne Going St, Portland, OR 97218 |
| Street Address |
4017 MINNESOTA AVE NE |
| City | WASHINGTON |
| State | DC |
| Zip Code | 20019-3541 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457963019 | Dominique Mooskin | Social Worker | 4017 Minnesota Ave Ne, Washington, DC 20019-3541 | 2020-08-17 |
| 1356900476 | Virginia Lee Madden | Counselor | 4017 Minnesota Ave Ne, Washington, DC 20019-3541 | 2019-06-12 |
| 1215405808 | Mikekisha Leshawn Shannon | Home Health Aide | 4017 Minnesota Ave Ne, Washington, DC 20019-3541 | 2018-11-13 |
| 1740775337 | Kyle T. Collins | Social Worker | 4017 Minnesota Ave Ne, Washington, DC 20019-3541 | 2018-06-26 |
| 1063906931 | Tatiana Laurie Pouadeu Djongoue | Home Health Aide | 4017 Minnesota Ave Ne, Washington, DC 20019-3541 | 2018-06-14 |
| 1821504176 | Dennis John Carter | Counselor | 4017 Minnesota Ave Ne, Washington, DC 20019-3541 | 2017-12-22 |
| 1205216637 | Tara Catherine Fleming | Social Worker | 4017 Minnesota Ave Ne, Washington, DC 20019-3541 | 2015-06-01 |
| 1215317680 | Gregory Mathis | Counselor | 4017 Minnesota Ave Ne, Washington, DC 20019-3541 | 2015-06-01 |
| 1154733251 | Teresa Lewis | Counselor | 4017 Minnesota Ave Ne, Washington, DC 20019-3541 | 2014-05-22 |
| 1467889519 | Heather V Geldon | Social Worker | 4017 Minnesota Ave Ne, Washington, DC 20019-3541 | 2013-10-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568079440 | Gracefully Fulfilled Counseling and Coaching Services | Counselor | 219 56th Place Ne, Washington, DC 20019 | 2020-09-25 |
| 1033735170 | Regenia Elizabeth Sayles | Home Health Aide | 3924 Minnesota Ave Ne Washington, Dc, DC 20019 | 2020-06-24 |
| 1417578733 | Alycia Paige Heiner | Student in an Organized Health Care Education/Training Program | Parkside Health Center, 765 Kenilworth Terrace Ne, Washington, DC 20019 | 2020-04-27 |
| 1598398786 | Issa Munu | Technician | 45th Street Ne, 604, Washington, DC 20019 | 2020-02-17 |
| 1538708391 | Chanda Constance Mcmahan | Psychologist | 3320 Ames St. N.e., Washington, DC 20019 | 2019-12-27 |
| 1215582978 | Howard University | Clinic/Center | 4414-4430 Benning Road, Ne, Washington, DC 20019 | 2019-08-08 |
| 1255985776 | Kemba Kelton | Technician | 3204 1/2 East Capitol Street Nw, Washington, DC 20019 | 2019-08-01 |
| 1659930196 | Brittany Deshanta Fleming | Counselor | 1561 45th St Ne, Washington, DC 20019 | 2019-06-09 |
| 1346701299 | Chelsie Esek | Speech-Language Pathologist | 1234 Singleton Blvd., Washington Dc, DC 20019 | 2019-03-25 |
| 1174081434 | Kathleen Estelle Williams | Nurse's Aide | 12045th Street North East, 613, Washington, DC 20019 | 2019-03-06 |
| Find all providers in zip 20019 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184955759 | Gospel Rescue Ministries of Washington, Dc, Inc. | Clinic/Center | 810 5th St Nw, Washington, DC 20001-2622 | 2010-01-21 |
| 1548430226 | Federal City Recovery Services | Clinic/Center | 920 Bellevue St Se, Washington, DC 20032-6030 | 2008-03-10 |
| 1740468008 | New Destinaton LLC | Clinic/Center | 1424 Pennsylvania Ave Se, Washington, DC 20003-3029 | 2008-02-08 |
| 1912027715 | Neighbors' Consejo | Clinic/Center | 3118 16th Street Nw, Washington, DC 20010 | 2007-03-29 |
| 1598805335 | Latin American Youth Center | Clinic/Center | 1419 Columbia Rd Nw, Washington, DC 20009-4705 | 2007-02-08 |
| 1043833783 | District Healthcare Services, LLC | Clinic/Center | 2811 Pennsylvania Ave Se, Washington, DC 20020-3865 | 2020-05-28 |
| 1932688314 | Volunteers of America Chesapeake Inc. | Clinic/Center | 508 Kennedy St Nw Fl 2, Washington, DC 20011-3010 | 2018-08-07 |
| 1326468950 | Shona House | Clinic/Center | 920 Bellevue St Se, Washington, DC 20032-6030 | 2014-04-22 |
| 1346472412 | United Planning Organization | Clinic/Center | 1900 Mass Ave Se, Bldg. 13, Washington, DC 20003-2542 | 2009-08-21 |
| 1013183565 | The Salvation Army Harbor Light Center | Clinic/Center | 2100 New York Ave Ne, Washington, DC 20002-1826 | 2008-05-05 |
| Find all providers in WASHINGTON | ||||
| City | WASHINGTON |
| Zip Code | 20019 |
Please comment or provide details below to improve the information on SECOND GENESIS.
| 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.