Healthcare Provider Details

I. General information

NPI: 1487430864
Provider Name (Legal Business Name): RESTORED LIFE HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S REED RD
KOKOMO IN
46901-4900
US

IV. Provider business mailing address

302 S REED RD
KOKOMO IN
46901-4900
US

V. Phone/Fax

Practice location:
  • Phone: 765-780-7689
  • Fax:
Mailing address:
  • Phone: 765-780-7689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVID CHRISTENSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 765-780-7689