| Renewed Oaks Therapy Llc | |
|
128 Southwinds Rd Farmington AR 72730-8678 | |
| (479) 267-6934 | |
| Not Available |
| Full Name | Renewed Oaks Therapy Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 128 Southwinds Rd, Farmington, Arkansas |
| Authorized Official Name and Position | Adam Persenaire (THERAPIST) |
| Authorized Official Contact | 4798795916 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renewed Oaks Therapy Llc Po Box 34 Prairie Grove AR 72753-0034 Ph: () - | Renewed Oaks Therapy Llc 128 Southwinds Rd Farmington AR 72730-8678 Ph: (479) 267-6934 |
| NPI Number | 1710717392 |
|---|---|
| Provider Enumeration Date | 08/07/2024 |
| Last Update Date | 08/07/2024 |
| Certification Date | 08/07/2024 |
| Medicare PECOS PAC ID | 8729515242 |
|---|---|
| Medicare Enrollment ID | O20241223001976 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710717392 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Adam N Persenaire |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518795657 PECOS PAC ID: 0042747057 Enrollment ID: I20250108000759 |
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