Provider Demographics
NPI:1437533908
Name:RESTORE HEALTHCARE
Entity Type:Organization
Organization Name:RESTORE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-559-9409
Mailing Address - Street 1:2764 PLEASANT RD
Mailing Address - Street 2:STE 10909
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7299
Mailing Address - Country:US
Mailing Address - Phone:704-559-9408
Mailing Address - Fax:704-731-0975
Practice Address - Street 1:2764 PLEASANT RD
Practice Address - Street 2:STE 10909
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7299
Practice Address - Country:US
Practice Address - Phone:704-559-9408
Practice Address - Fax:704-731-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1457795510Medicaid