Provider Demographics
NPI:1467847657
Name:RESTORATION AND RECOVERY, LLC
Entity Type:Organization
Organization Name:RESTORATION AND RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIVELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNEZ-RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CADC-I
Authorized Official - Phone:702-750-9387
Mailing Address - Street 1:6120 SKOKIE COURT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130
Mailing Address - Country:US
Mailing Address - Phone:702-374-8500
Mailing Address - Fax:
Practice Address - Street 1:811 S DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3933
Practice Address - Country:US
Practice Address - Phone:702-750-9387
Practice Address - Fax:702-790-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01316-INTERN101YA0400X
NV01306101YM0800X
NV6766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty