RESTORED LIFE SERVICES OF ARKANSAS INC
NPI 1558727024
Counselor - Addiction (Substance Use Disorder) in Russellville, AR

Q: What is Restored Life Services Of Arkansas Inc's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Active since January 13, 2016

107 N BOSTON PL, RUSSELLVILLE, AR 72801(479) 219-4100(479) 222-0049 Get Directions Write a Review

NPPES record last updated: December 30, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Dec 30, 2025, Aug 9, 2025, May 21, 2025 and 3 more (6 updates tracked since 2016).

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About Restored Life Services Of Arkansas Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RESTORED LIFE SERVICES OF ARKANSAS INC (NPI 1558727024) is a healthcare organization registered as an addiction (substance use disorder) in Russellville, Arkansas and active in the NPI registry since January 2016. The organization lists Mary Caitlin Conner, Owner, as its authorized official.

NPPES Registry Identity

NPI1558727024

Entity TypeOrganization

Primary Taxonomy101YA0400X

Legal Business NameRESTORED LIFE SERVICES OF ARKANSAS INC

Location Address107 N BOSTON PLRussellville, AR 72801-3940

Mailing AddressPo Box 9178Russellville, AR 72811-9178 · (800) 824-4094 · Fax (479) 968-1673

Phone(479) 219-4100

Fax(479) 222-0049

Organization SubpartNo

Authorized OfficialMary Caitlin ConnerOwner · (479) 219-4100

Enumeration DateJanuary 13, 2016

Last NPPES UpdateDecember 30, 20256 updates tracked since enumeration

NPPES CertifiedDecember 30, 2025

✔ NPI 1558727024 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers

Taxonomy Code101YA0400X

107 N BOSTON PL, Russellville, AR 72801

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Other Names 1

Other NameRestored Life Services

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Restored Life Services Of Arkansas Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Restored Life Services Of Arkansas Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Paul Hickerson, PHD, LPC

Mental Health Counselor

NPI 1134411036

106 E MAIN
Russellville, AR 72801

(479) 692-1208

✔ PECOS0.1 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Restored Life Services Of Arkansas Inc's NPI number?

The NPI number for Restored Life Services Of Arkansas Inc is 1558727024. It was assigned to this organization in the NPPES registry on January 13, 2016. The provider is also known as Restored Life Services.

Where is Restored Life Services Of Arkansas Inc located?

Restored Life Services Of Arkansas Inc is located at 107 N Boston Pl, Russellville, AR 72801. The listed phone number is (479) 219-4100.

What is Restored Life Services Of Arkansas Inc's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Is Restored Life Services Of Arkansas Inc enrolled in Medicare?

Yes. Restored Life Services Of Arkansas Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Restored Life Services Of Arkansas Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Mental Health Counselor) reassigns their Medicare billing to Restored Life Services Of Arkansas Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Restored Life Services Of Arkansas Inc was last updated on December 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.