Provider Demographics
NPI:1811031107
Name:RESTORATION CONCEPTS, INC.
Entity Type:Organization
Organization Name:RESTORATION CONCEPTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-481-8379
Mailing Address - Street 1:809 N LAFAYETTE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3978
Mailing Address - Country:US
Mailing Address - Phone:704-481-8379
Mailing Address - Fax:704-481-8571
Practice Address - Street 1:809 N LAFAYETTE ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3978
Practice Address - Country:US
Practice Address - Phone:704-481-8379
Practice Address - Fax:704-481-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301845GMedicaid
NC8301845QMedicaid
NC8301845Medicaid
NC8301845VMedicaid
NC8301845BMedicaid
NC8301845BMedicaid