Healthcare Provider Details

I. General information

NPI: 1609240779
Provider Name (Legal Business Name): RESTORE HEALTH MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 ELDRON BLVD SE SUITE 1
PALM BAY FL
32909-6871
US

IV. Provider business mailing address

1840 ELDRON BLVD SE SUITE 1
PALM BAY FL
32909-6871
US

V. Phone/Fax

Practice location:
  • Phone: 321-312-4580
  • Fax: 321-914-4053
Mailing address:
  • Phone: 321-312-4580
  • Fax: 321-914-4053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HUSTED
Title or Position: CLINIC MANAGER
Credential:
Phone: 321-312-4580