MEDICARE: 2ND GENESIS FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1184423972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2ND GENESIS FOUNDATION

Provider Business Mailing Address
First Line	:	222 S MERAMEC AVE STE 202-1126
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1805
Country	:	US
Telephone Number	:	844-524-0234
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 S MERAMEC AVE STE 202-1126
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1805
Country	:	US
Telephone Number	:	844-524-0234
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. CALVIN SPINKS
Credential	:	MA ED.D
Telephone Number	:	314-482-4993

Provider Enumeration Date	:	03/12/2025
Last Update Date	:	03/12/2025

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