Provider Demographics
NPI:1518297431
Name:RESTORATIVE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:RESTORATIVE HEALTH SERVICES LLC
Other - Org Name:COASTAL HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:210-907-7163
Mailing Address - Street 1:6655 FIRST PARK TEN BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4304
Mailing Address - Country:US
Mailing Address - Phone:210-907-7163
Mailing Address - Fax:210-600-9799
Practice Address - Street 1:6000 S STAPLES ST STE 403B
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2952
Practice Address - Country:US
Practice Address - Phone:361-758-5200
Practice Address - Fax:361-758-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747542Medicare Oscar/Certification