| Rehoboth Mental Health And Psychaitry Pllc | |
|
1475 Heritage Pkwy Ste 209 Mansfield TX 76063-2740 | |
| (817) 523-8812 | |
| (817) 241-1947 |
| Full Name | Rehoboth Mental Health And Psychaitry Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1475 Heritage Pkwy Ste 209, Mansfield, Texas |
| Authorized Official Name and Position | Omotayo Gbengaojo (OWNER/AUTHORISED OFFICIAL) |
| Authorized Official Contact | 8175238812 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rehoboth Mental Health And Psychaitry Pllc 7133 Pampas Pl Venus TX 76084-3756 Ph: (817) 523-8812 | Rehoboth Mental Health And Psychaitry Pllc 1475 Heritage Pkwy Ste 209 Mansfield TX 76063-2740 Ph: (817) 523-8812 |
| NPI Number | 1053156331 |
|---|---|
| Provider Enumeration Date | 06/27/2024 |
| Last Update Date | 05/20/2025 |
| Certification Date | 05/20/2025 |
| Medicare PECOS PAC ID | 1153868492 |
|---|---|
| Medicare Enrollment ID | O20240803000407 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053156331 | NPI | - | NPPES |
| Provider Name | Omotayo Theresa Gbengaojo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972201895 PECOS PAC ID: 3173985470 Enrollment ID: I20230818000869 |
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