Organization
SECOND GENESIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. J. MICHAEL MCGUINNESS M.S.W. (EXECUTIVE DIRECTOR)
(301) 563-1545
Entity
Organization
Contact information
Practice address
4017 MINNESOTA AVE NE, WASHINGTON, DC 20019-3541
(202) 388-8570
(202) 388-3523
Mailing address
8611 2ND AVE, SUITE 300, SILVER SPRING, MD 20910-3372
(301) 563-1545
(301) 563-1546
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
111507A-171
DC
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
111507A-Y-170
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003084146
—
MD
05
—
1053589242
—
MD
05
—
1316115454
—
MD
05
—
1790766855
—
DC
Enumeration date
09/16/2008
Last updated
09/16/2008
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