Provider Demographics
NPI:1609240779
Name:RESTORE HEALTH MANAGEMENT LLC
Entity Type:Organization
Organization Name:RESTORE HEALTH MANAGEMENT LLC
Other - Org Name:RESTORE HEALTH URGENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSTED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-312-4580
Mailing Address - Street 1:1840 ELDRON BLVD SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6871
Mailing Address - Country:US
Mailing Address - Phone:321-312-4580
Mailing Address - Fax:321-914-4053
Practice Address - Street 1:1840 ELDRON BLVD SE
Practice Address - Street 2:SUITE 1
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6871
Practice Address - Country:US
Practice Address - Phone:321-312-4580
Practice Address - Fax:321-914-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care