Healthcare Provider Details

I. General information

NPI: 1821971169
Provider Name (Legal Business Name): RESTORATION CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FORE ST
PORTLAND ME
04101-4879
US

IV. Provider business mailing address

100 FORE ST
PORTLAND ME
04101-4879
US

V. Phone/Fax

Practice location:
  • Phone: 781-346-4461
  • Fax:
Mailing address:
  • Phone: 781-346-4461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TOM HUNTER
Title or Position: SECRETARY
Credential:
Phone: 781-346-4461