Provider Demographics
NPI:1912162751
Name:RESTORE HEALTH & COUNSELING
Entity Type:Organization
Organization Name:RESTORE HEALTH & COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:RADNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-307-8855
Mailing Address - Street 1:4705 PARIS ST
Mailing Address - Street 2:# 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-2860
Mailing Address - Country:US
Mailing Address - Phone:303-307-8855
Mailing Address - Fax:303-307-8666
Practice Address - Street 1:4705 PARIS ST
Practice Address - Street 2:# 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-2860
Practice Address - Country:US
Practice Address - Phone:303-307-8855
Practice Address - Fax:303-307-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1630-01251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1630-01OtherALCOHOL AND DRUG ABUSE DIVISION (ADAD)