| Pure Life Therapy, Llc | |
|
11580 W Dodge Rd Omaha NE 68154-2537 | |
| (402) 238-1431 | |
| Not Available |
| Full Name | Pure Life Therapy, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11580 W Dodge Rd, Omaha, Nebraska |
| Authorized Official Name and Position | Lisa Dunlavy (OWNER) |
| Authorized Official Contact | 4025433392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pure Life Therapy, Llc 11580 W Dodge Rd Omaha NE 68154-2537 Ph: (402) 238-1431 | Pure Life Therapy, Llc 11580 W Dodge Rd Omaha NE 68154-2537 Ph: (402) 238-1431 |
| NPI Number | 1578291092 |
|---|---|
| Provider Enumeration Date | 08/11/2022 |
| Last Update Date | 08/11/2022 |
| Certification Date | 08/11/2022 |
| Medicare PECOS PAC ID | 1850749367 |
|---|---|
| Medicare Enrollment ID | O20231122000482 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578291092 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Lisa M Dunlavy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922698711 PECOS PAC ID: 2769830272 Enrollment ID: I20231122000524 |
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