RESTORE HEALTHCARE MEDICAL GROUP NPI 1184120750

NPI Information

NPI: 1184120750
Provider Name: RESTORE HEALTHCARE MEDICAL GROUP

Other Name: RESTORE HEALTHCARE MEDICAL GROUP

Classification: Counselor - 101Y00000X
Entity Type: Organization
Address:
330 CAMP RD STE B43
CHARLOTTE, NC
ZIP 28206
Phone: (888) 661-7730
Get Directions

RESTORE HEALTHCARE MEDICAL GROUP is a counselor in Charlotte, NC. The provider is a provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification. RESTORE HEALTHCARE MEDICAL GROUP NPI is 1184120750. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Restore Healthcare Medical Group.

The provider's business location address is:

330 CAMP RD STE B43
CHARLOTTE, NC
ZIP 28206-005
Phone: (888) 661-7730
Fax: (888) 813-2442

The provider's authorized official is Christina Jarrett .
The authorized official title is Executive Director and has the following contact phone number (704) 559-9409.

The enumeration date for this NPI number is 4/3/2018 and was last updated on 10/28/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	171M00000X	Case Manager/Care Coordinator		No
2	208000000X	Pediatrics		No
3	224ZE0001X	Occupational Therapy Assistant	Environmental Modification	No
4	235Z00000X	Speech-Language Pathologist		No
5	251B00000X	Case Management		No
6	251C00000X	Day Training, Developmentally Disabled Services		No
7	251S00000X	Community/Behavioral Health		No
8	252Y00000X	Early Intervention Provider Agency		No
9	253Z00000X	In Home Supportive Care		No
10	261QD1600X	Clinic/Center	Developmental Disabilities	No
11	261QP2000X	Clinic/Center	Physical Therapy	No
12	261QR0400X	Clinic/Center	Rehabilitation	No
13	261QX0100X	Clinic/Center	Occupational Medicine	No
14	385HR2060X	Respite Care	Respite Care, Intellectual and/or Developmental Disabilities	No
15	101Y00000X	Counselor		Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	=========	MEDICAID	NORTH CAROLINA
2	=========	MEDICAID	SOUTH CAROLINA
3	=========	OTHER		MANAGED CARE PROVIDER INSURANCE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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