Provider Demographics
NPI:1457795510
Name:RESTORE HEALTHCARE
Entity type:Organization
Organization Name:RESTORE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:COBBS
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-559-9408
Mailing Address - Street 1:4258 HIGHWAY 49 S
Mailing Address - Street 2:STE 554
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-0345
Mailing Address - Country:US
Mailing Address - Phone:704-559-9408
Mailing Address - Fax:704-731-0975
Practice Address - Street 1:4350 MAIN ST
Practice Address - Street 2:SUITE 211
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7433
Practice Address - Country:US
Practice Address - Phone:704-559-9408
Practice Address - Fax:704-731-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC133NN1002X, 163WC0400X, 163WG0000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========Medicaid