Provider Demographics
NPI:1700695954
Name:RESTORE -RECOVER-RENEW LLC
Entity type:Organization
Organization Name:RESTORE -RECOVER-RENEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:210-793-2284
Mailing Address - Street 1:274 BOBWHITE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6977
Mailing Address - Country:US
Mailing Address - Phone:210-793-2284
Mailing Address - Fax:
Practice Address - Street 1:274 BOBWHITE WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6977
Practice Address - Country:US
Practice Address - Phone:107-932-2842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAUFFMAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health