Provider Demographics
NPI:1912666322
Name:RESTORE WELLNESS CENTER INC.
Entity Type:Organization
Organization Name:RESTORE WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLTAU
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:978-233-4994
Mailing Address - Street 1:144 NORTH RD STE 3150
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1156
Mailing Address - Country:US
Mailing Address - Phone:978-233-4990
Mailing Address - Fax:978-233-4991
Practice Address - Street 1:144 NORTH RD STE 3150
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1183
Practice Address - Country:US
Practice Address - Phone:978-233-4990
Practice Address - Fax:978-233-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center