Provider Demographics
NPI:1770011652
Name:RESTORATION RECOVERY, PLLC
Entity Type:Organization
Organization Name:RESTORATION RECOVERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAOLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-498-2005
Mailing Address - Street 1:6141 SHALLOWFORD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1663
Mailing Address - Country:US
Mailing Address - Phone:423-498-2000
Mailing Address - Fax:423-498-2001
Practice Address - Street 1:6141 SHALLOWFORD RD STE 100
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1663
Practice Address - Country:US
Practice Address - Phone:423-498-2000
Practice Address - Fax:423-498-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 2083A0300X
TNDO0000002663208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003147609AMedicaid
TNQ028699Medicaid