| Aglow Recovery Healthcare Services | |
|
1647 Benning Rd Ne Ste 300a Washington DC 20002-4572 | |
| (202) 621-8713 | |
| (202) 946-7091 |
| Full Name | Aglow Recovery Healthcare Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 1647 Benning Rd Ne Ste 300a, Washington, District Of Columbia |
| Authorized Official Name and Position | Kerniba Y Ghoneim (CO-OWNER) |
| Authorized Official Contact | 2026218713 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aglow Recovery Healthcare Services 2490 Market St Ne # 630 Washington DC 20018-3851 Ph: (202) 621-8713 | Aglow Recovery Healthcare Services 1647 Benning Rd Ne Ste 300a Washington DC 20002-4572 Ph: (202) 621-8713 |
| NPI Number | 1710699137 |
|---|---|
| Provider Enumeration Date | 12/16/2022 |
| Last Update Date | 02/14/2023 |
| Medicare PECOS PAC ID | 8921472754 |
|---|---|
| Medicare Enrollment ID | O20230318000066 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710699137 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
| Provider Name | Opeyinka Kayode Adesunloye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215601893 PECOS PAC ID: 5496140667 Enrollment ID: I20220325000195 |
| Provider Name | Maragaret Arotimi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699420448 PECOS PAC ID: 2466833207 Enrollment ID: I20220728003148 |
| Provider Name | Ayoola Juliana Oyenuga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982172664 PECOS PAC ID: 6204169469 Enrollment ID: I20221219000299 |
| Provider Name | Kerniba Ghoneim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568036382 PECOS PAC ID: 0749679231 Enrollment ID: I20230218000314 |
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