Provider Demographics
NPI:1114168010
Name:HH RESTORATIVE GROUP, LLC
Entity Type:Organization
Organization Name:HH RESTORATIVE GROUP, LLC
Other - Org Name:COASTAL HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:SOREN
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:361-290-2406
Mailing Address - Street 1:4721 CONSTANCE ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5242
Mailing Address - Country:US
Mailing Address - Phone:361-290-2406
Mailing Address - Fax:361-334-0375
Practice Address - Street 1:4721 CONSTANCE ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5242
Practice Address - Country:US
Practice Address - Phone:361-290-2406
Practice Address - Fax:361-334-0375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health