Provider Demographics
NPI:1518009828
Name:RESTORATIVE IDEAS & SOLUTIONS, INC.
Entity Type:Organization
Organization Name:RESTORATIVE IDEAS & SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-742-8614
Mailing Address - Street 1:1028 N SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-1450
Mailing Address - Country:US
Mailing Address - Phone:219-763-0379
Mailing Address - Fax:219-763-0379
Practice Address - Street 1:6641 MELTON RD STE A
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-1885
Practice Address - Country:US
Practice Address - Phone:219-763-0379
Practice Address - Fax:219-763-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200283440 AMedicaid
IN200283440 AMedicaid