Provider Demographics
NPI:1053589242
Name:SECOND GENESIS, INC
Entity type:Organization
Organization Name:SECOND GENESIS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCGUINNESS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:301-563-1545
Mailing Address - Street 1:8611 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3372
Mailing Address - Country:US
Mailing Address - Phone:301-563-1545
Mailing Address - Fax:301-563-1546
Practice Address - Street 1:107 CIRCLE DR
Practice Address - Street 2:TARDITIONAL
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-2061
Practice Address - Country:US
Practice Address - Phone:301-621-9013
Practice Address - Fax:301-563-1546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility