NPIMap

Organization Active NPI

Aglow Recovery Healthcare Services

  • Multi-Specialty Clinic/Center
  • Washington, DC
National Provider Identifier
1710699137
Registry record updated Feb 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
AGLOW RECOVERY HEALTHCARE SERVICES
Practice address
1647 Benning Rd NE Ste 300a
Washington, DC 20002-4572
Phone
(202) 621-8713
Fax
(202) 946-7091
NPI assigned
Dec 16, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kerniba Y GhoneimNPI 1568036382
Title
Co-Owner
Phone
(202) 621-8713

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

1647 Benning Rd NE Ste 300a
Washington, DC 20002-4572

Mailing address

2490 Market St NE # 630
Washington, DC 20018-3851
Phone (202) 621-8713

National Provider Directory

National Provider Directory

Locations

1647 Benning Rd NE
Ste 300
Washington, DC 20002
Phone (202) 621-8713

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676332800000",
    "number": "1710699137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2490 MARKET ST NE # 630",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200183851",
            "telephone_number": "202-621-8713",
            "fax_number": "202-946-7091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1647 BENNING RD NE STE 300A",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200024572",
            "telephone_number": "202-621-8713",
            "fax_number": "202-946-7091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGLOW RECOVERY HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-16",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A",
        "authorized_official_last_name": "GHONEIM",
        "authorized_official_first_name": "KERNIBA",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "202-621-8713"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.