Provider Demographics
NPI:1295222966
Name:RESTART RECOVERY LLC
Entity Type:Organization
Organization Name:RESTART RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-303-2743
Mailing Address - Street 1:1018 S MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2961
Mailing Address - Country:US
Mailing Address - Phone:217-303-2743
Mailing Address - Fax:
Practice Address - Street 1:21 DOCTORS PARK STE A
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4927
Practice Address - Country:US
Practice Address - Phone:217-303-2743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center