| Restore Rebuild Reconnect Counseling Center | |
|
1941 S 42nd St Ste 523 Omaha NE 68105-2982 | |
| (402) 917-1054 | |
| Not Available |
| Full Name | Restore Rebuild Reconnect Counseling Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1941 S 42nd St Ste 523, Omaha, Nebraska |
| Authorized Official Name and Position | Larhonda Flowers (OWNER) |
| Authorized Official Contact | 4029171054 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restore Rebuild Reconnect Counseling Center 1941 S 42nd St Ste 523 Omaha NE 68105-2982 Ph: (402) 917-1054 | Restore Rebuild Reconnect Counseling Center 1941 S 42nd St Ste 523 Omaha NE 68105-2982 Ph: (402) 917-1054 |
| NPI Number | 1679128318 |
|---|---|
| Provider Enumeration Date | 08/08/2019 |
| Last Update Date | 12/23/2019 |
| Certification Date | 12/23/2019 |
| Medicare PECOS PAC ID | 3678910809 |
|---|---|
| Medicare Enrollment ID | O20240325000879 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679128318 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Petrisor Tudor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194447367 PECOS PAC ID: 3779950159 Enrollment ID: I20221028000848 |
| Provider Name | Larhonda Flowers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720464795 PECOS PAC ID: 8022455252 Enrollment ID: I20240325000935 |
| Provider Name | Albert Todd Sparks |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811493935 PECOS PAC ID: 0547609711 Enrollment ID: I20240419003532 |
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