Provider Demographics
NPI:1720763592
Name:RESTORING HEALTH OUTPATIENT CLINIC, INC.
Entity Type:Organization
Organization Name:RESTORING HEALTH OUTPATIENT CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-737-6961
Mailing Address - Street 1:1150 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-2224
Mailing Address - Country:US
Mailing Address - Phone:602-675-1429
Mailing Address - Fax:
Practice Address - Street 1:1150 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2224
Practice Address - Country:US
Practice Address - Phone:602-675-1429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health