Provider Demographics
NPI:1770191272
Name:RESTORATION THERAPY
Entity Type:Organization
Organization Name:RESTORATION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MENTAL HEALTH &SUBSTANCE USE
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HABRICH
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, CPC, LADC
Authorized Official - Phone:402-813-2255
Mailing Address - Street 1:6648 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-1136
Mailing Address - Country:US
Mailing Address - Phone:402-813-2255
Mailing Address - Fax:
Practice Address - Street 1:6648 CHARLES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-1136
Practice Address - Country:US
Practice Address - Phone:402-813-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1558817759Medicaid