Provider Demographics
NPI:1184711392
Name:RESTART, INC
Entity type:Organization
Organization Name:RESTART, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLISSIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-324-2622
Mailing Address - Street 1:PO BOX 21530
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89721-1530
Mailing Address - Country:US
Mailing Address - Phone:775-884-2455
Mailing Address - Fax:775-884-0345
Practice Address - Street 1:335 RECORD ST
Practice Address - Street 2:#155
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-3327
Practice Address - Country:US
Practice Address - Phone:775-324-2622
Practice Address - Fax:775-324-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4954-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1184711392Medicaid