Provider Demographics
NPI:1679128318
Name:RESTORE REBUILD RECONNECT COUNSELING CENTER
Entity Type:Organization
Organization Name:RESTORE REBUILD RECONNECT COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP LADC
Authorized Official - Phone:402-917-1054
Mailing Address - Street 1:1941 S 42ND ST STE 523
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2982
Mailing Address - Country:US
Mailing Address - Phone:402-917-1054
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST STE 523
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2982
Practice Address - Country:US
Practice Address - Phone:402-917-1054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health