| Re- Connect My Life Inc. | |
|
1121 Villa Linde Ct Flint MI 48532-3410 | |
| (810) 515-1931 | |
| Not Available |
| Full Name | Re- Connect My Life Inc. |
|---|---|
| Speciality | Counselor |
| Location | 1121 Villa Linde Ct, Flint, Michigan |
| Authorized Official Name and Position | Shuntai Walker (CLINICAL OWNER) |
| Authorized Official Contact | 8105151931 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Re- Connect My Life Inc. Po Box 320414 Flint MI 48532-0008 Ph: (810) 515-1931 | Re- Connect My Life Inc. 1121 Villa Linde Ct Flint MI 48532-3410 Ph: (810) 515-1931 |
| NPI Number | 1548637143 |
|---|---|
| Provider Enumeration Date | 08/31/2015 |
| Last Update Date | 03/12/2019 |
| Medicare PECOS PAC ID | 2769725696 |
|---|---|
| Medicare Enrollment ID | O20190516002275 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548637143 | NPI | - | NPPES |
| Provider Name | Ayana Fordham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326285156 PECOS PAC ID: 4385987213 Enrollment ID: I20190516002373 |
| Provider Name | Samara Lynn Hough |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649587833 PECOS PAC ID: 7911231162 Enrollment ID: I20190622000300 |
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