Provider Demographics
NPI:1073938288
Name:RESTORATIVE HEALTH
Entity Type:Organization
Organization Name:RESTORATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXSIJE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEKIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-417-6875
Mailing Address - Street 1:1027 S RAINBOW BLVD
Mailing Address - Street 2:369
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-6232
Mailing Address - Country:US
Mailing Address - Phone:702-417-6875
Mailing Address - Fax:
Practice Address - Street 1:4224 ARCATA WAY
Practice Address - Street 2:A
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3381
Practice Address - Country:US
Practice Address - Phone:702-417-6875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty