Provider Demographics
NPI:1801166103
Name:RESTART LIFE, PLLC
Entity type:Organization
Organization Name:RESTART LIFE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COSETTE
Authorized Official - Middle Name:DAWNA
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:800-682-6934
Mailing Address - Street 1:1001 290TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:FALL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:98024-7403
Mailing Address - Country:US
Mailing Address - Phone:800-682-6934
Mailing Address - Fax:888-788-3419
Practice Address - Street 1:2002 156TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007
Practice Address - Country:US
Practice Address - Phone:800-682-6934
Practice Address - Fax:888-788-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60152285101YM0800X
WA101YM0800X, 1041C0700X
WARN00086253163W00000X
251S00000X, 323P00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility