NPIMap

Organization Active NPI

Second Genesis

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Washington, DC
National Provider Identifier
1740439603
Registry record updated Sep 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
111507A-Y-170 Issued in DC
Legal business name
SECOND GENESIS
Practice address
4017 Minnesota Ave NE
Washington, DC 20019-3541
Phone
(202) 388-8570
Fax
(202) 388-3523
NPI assigned
Sep 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2008

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

Authorized official

Name
Mr. J. Michael McGuinness, M.S.W.
Title
Executive Director
Phone
(301) 563-1545

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 111507A-Y-170 DC Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 111507A-171 DC

Addresses

Primary practice location

4017 Minnesota Ave NE
Washington, DC 20019-3541

Mailing address

8611 2ND Ave
Suite 300
Silver Spring, MD 20910-3372
Phone (301) 563-1545

Other identifiers 4

IdentifierTypeStateIssuer
1316115454MedicaidMD
1003084146MedicaidMD
1053589242MedicaidMD
1790766855MedicaidDC

National Provider Directory

National Provider Directory
Tax ID family
Second Genesis Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4017 Minnesota Ave NE
Washington, DC 20019
Phone (202) 388-9202

8611 2nd Ave
Ste 300
Silver Spring, MD 20910
Phone (301) 563-1545

NPI Registry JSON

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

{
    "created_epoch": "1221523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221523200000",
    "number": "1740439603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8611 2ND AVE",
            "address_2": "SUITE 300",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209103372",
            "telephone_number": "301-563-1545",
            "fax_number": "301-563-1546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4017 MINNESOTA AVE NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200193541",
            "telephone_number": "202-388-8570",
            "fax_number": "202-388-3523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND GENESIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-16",
        "last_updated": "2008-09-16",
        "status": "A",
        "authorized_official_last_name": "MCGUINNESS",
        "authorized_official_first_name": "J.",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "301-563-1545",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.S.W."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "DC",
            "license": "111507A-Y-170",
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "DC",
            "license": "111507A-171",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316115454",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003084146",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053589242",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790766855",
            "state": "DC"
        }
    ],
    "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 Sep 16, 2008; 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.