Provider Demographics
NPI:1255622957
Name:RESTORATIVE HEALTH AND HEALING CENTER LLC
Entity type:Organization
Organization Name:RESTORATIVE HEALTH AND HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIEVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-239-0173
Mailing Address - Street 1:10201 ARCOS AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-9461
Mailing Address - Country:US
Mailing Address - Phone:314-239-0173
Mailing Address - Fax:239-948-0179
Practice Address - Street 1:10201 ARCOS AVE STE 201
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-9461
Practice Address - Country:US
Practice Address - Phone:314-239-0173
Practice Address - Fax:239-948-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty