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General NPI Number Information
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NPI Number | 1710699137
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Entity Type | Organization
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Legal Business Name | AGLOW RECOVERY HEALTHCARE SERVICES
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Dates
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Enumeration Date | 12/16/2022
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 1647 BENNING RD NE STE 300A
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City | WASHINGTON
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State | DC
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Zip | 20002-4572
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Country | US
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Telephone | 202-621-8713
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Fax | 202-946-7091
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Provider Business Mailing Address
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Address Line | 2490 MARKET ST NE # 630
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City | WASHINGTON
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State | DC
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Zip | 20018-3851
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Country | US
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Telephone | 202-621-8713
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Fax | 202-946-7091
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Authorized Official
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Title or Position | CO-OWNER
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Name | KERNIBA Y GHONEIM
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Credential |
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Telephone | 202-621-8713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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