Provider Demographics
NPI:1306671326
Name:REAL CONNECTIONS RETREATS LLC
Entity type:Organization
Organization Name:REAL CONNECTIONS RETREATS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, COO
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELGERSMA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:515-329-6336
Mailing Address - Street 1:2540 106TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3736
Mailing Address - Country:US
Mailing Address - Phone:515-635-1805
Mailing Address - Fax:
Practice Address - Street 1:2540 106TH ST STE 202
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3736
Practice Address - Country:US
Practice Address - Phone:515-635-1805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health