Provider Demographics
NPI:1902183338
Name:RESTORATION COUNSELING & COMMUNITY SERVICES, LLC
Entity Type:Organization
Organization Name:RESTORATION COUNSELING & COMMUNITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KUSTERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-767-6601
Mailing Address - Street 1:1901 44TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-1209
Mailing Address - Country:US
Mailing Address - Phone:612-767-6601
Mailing Address - Fax:612-767-6603
Practice Address - Street 1:1901 44TH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-1209
Practice Address - Country:US
Practice Address - Phone:612-767-6601
Practice Address - Fax:612-767-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1061726251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health