Provider Demographics
NPI:1770259061
Name:RESTORE WOUND CARE LLC
Entity Type:Organization
Organization Name:RESTORE WOUND CARE LLC
Other - Org Name:RESTORE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRIEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:709-729-2727
Mailing Address - Street 1:9195 GRANT ST STE 305
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4386
Mailing Address - Country:US
Mailing Address - Phone:720-678-9868
Mailing Address - Fax:720-678-9860
Practice Address - Street 1:9195 GRANT ST STE 301
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4386
Practice Address - Country:US
Practice Address - Phone:720-678-9868
Practice Address - Fax:720-678-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health