MEDICARE: RESTORE BEHAVIORAL HEALTH CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1407741473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORE BEHAVIORAL HEALTH CLINIC LLC

Provider Business Mailing Address
First Line	:	107 WESTFORD ST
Second Line	:
City	:	DUNSTABLE
State	:	MA
Zip	:	01827-2405
Country	:	US
Telephone Number	:	978-551-2218
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 BRICK KILN RD UNIT 210
Second Line	:
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-3259
Country	:	US
Telephone Number	:	978-225-8340
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	IRENE MUCHAI
Credential	:	APRN
Telephone Number	:	978-551-2218

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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