Provider Demographics
NPI:1750103008
Name:RESTORATIVE PSYCH LLC
Entity type:Organization
Organization Name:RESTORATIVE PSYCH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:NJOROGE
Authorized Official - Last Name:KIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP PMHNP-BC
Authorized Official - Phone:480-853-9709
Mailing Address - Street 1:14844 S 30TH ST STE 213
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8714
Mailing Address - Country:US
Mailing Address - Phone:732-322-1807
Mailing Address - Fax:480-383-6445
Practice Address - Street 1:1017 S GILBERT RD STE 213
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-4444
Practice Address - Country:US
Practice Address - Phone:480-853-9709
Practice Address - Fax:480-383-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)