Healthcare Provider Details

I. General information

NPI: 1770259061
Provider Name (Legal Business Name): RESTORE WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9195 GRANT ST STE 301
THORNTON CO
80229-4386
US

IV. Provider business mailing address

9195 GRANT ST STE 305
THORNTON CO
80229-4386
US

V. Phone/Fax

Practice location:
  • Phone: 720-678-9868
  • Fax: 720-678-9860
Mailing address:
  • Phone: 720-678-9868
  • Fax: 720-678-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHAWN BARRIEAU
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 709-729-2727