Provider Demographics
NPI:1942541669
Name:ACTIVE RESTORATION LLC
Entity Type:Organization
Organization Name:ACTIVE RESTORATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-287-1256
Mailing Address - Street 1:PO BOX 23163
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-0163
Mailing Address - Country:US
Mailing Address - Phone:925-287-1256
Mailing Address - Fax:925-287-0913
Practice Address - Street 1:2250 MORELLO AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1860
Practice Address - Country:US
Practice Address - Phone:925-287-1256
Practice Address - Fax:925-287-0913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty