| Restored Life Health Network | |
|
1236 N Wabash Ave Kokomo IN 46901-2604 | |
| (765) 780-7689 | |
| Not Available |
| Full Name | Restored Life Health Network |
|---|---|
| Speciality | Clinic/Center |
| Location | 1236 N Wabash Ave, Kokomo, Indiana |
| Authorized Official Name and Position | David Christenson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7657807689 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restored Life Health Network 302 S Reed Rd Kokomo IN 46901-4900 Ph: (765) 780-7689 | Restored Life Health Network 1236 N Wabash Ave Kokomo IN 46901-2604 Ph: (765) 780-7689 |
| NPI Number | 1487430864 |
|---|---|
| Provider Enumeration Date | 09/01/2023 |
| Last Update Date | 11/05/2024 |
| Medicare PECOS PAC ID | 3173973336 |
|---|---|
| Medicare Enrollment ID | O20231229001923 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487430864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Angela J Bowman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033280425 PECOS PAC ID: 8022174804 Enrollment ID: I20090303000279 |
| Provider Name | Theresa M Suozzi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952544199 PECOS PAC ID: 4981740016 Enrollment ID: I20140219000685 |
| Provider Name | Matthew Matteson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467096339 PECOS PAC ID: 7315370376 Enrollment ID: I20191204002620 |
| Provider Name | Anna Koblik Chen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972967982 PECOS PAC ID: 4789084195 Enrollment ID: I20240126002003 |
| Provider Name | Shani Berrios |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447026851 PECOS PAC ID: 2062859424 Enrollment ID: I20240320002805 |
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Eric J. Heathers Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3508 S Lafountain St, Kokomo, IN 46902 Phone: 765-864-5704 Fax: 765-864-5720 | |
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Sycamore Primary Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3109 W Sycamore St, Kokomo, IN 46901 Phone: 765-457-8381 Fax: 765-457-4443 | |
Indiana Health Centers, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3118 S Lafountain St, Kokomo, IN 46902 Phone: 765-864-4160 | |
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