Provider Demographics
NPI:1508645870
Name:MISSION RESTART INC.
Entity Type:Organization
Organization Name:MISSION RESTART INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAADE
Authorized Official - Suffix:
Authorized Official - Credentials:CPRSR, SPC, PSS
Authorized Official - Phone:218-812-9238
Mailing Address - Street 1:1007 NW 4TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2203
Mailing Address - Country:US
Mailing Address - Phone:218-999-4066
Mailing Address - Fax:
Practice Address - Street 1:1007 NW 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2203
Practice Address - Country:US
Practice Address - Phone:218-999-4066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty