Healthcare Provider Details

I. General information

NPI: 1851972806
Provider Name (Legal Business Name): RESTORATIVE PSYCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 S GILBERT RD STE 213
MESA AZ
85204-4444
US

IV. Provider business mailing address

14844 S 30TH ST
PHOENIX AZ
85048-8714
US

V. Phone/Fax

Practice location:
  • Phone: 732-322-1807
  • Fax: 480-383-6445
Mailing address:
  • Phone: 732-322-1807
  • Fax: 480-383-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH NJOROGE KIMANI
Title or Position: PRESIDENT
Credential: NP-DNP
Phone: 732-322-1807