Healthcare Provider Details

I. General information

NPI: 1487722112
Provider Name (Legal Business Name): RESTART, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 OLSON MEMORIAL HWY SUITE 610
GOLDEN VALLEY MN
55422-5351
US

IV. Provider business mailing address

4000 OLSON MEMORIAL HWY SUITE 610
GOLDEN VALLEY MN
55422-5351
US

V. Phone/Fax

Practice location:
  • Phone: 763-588-7633
  • Fax: 763-588-7613
Mailing address:
  • Phone: 763-588-7633
  • Fax: 763-588-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateMN

VIII. Authorized Official

Name: MR. JAMES JASPER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 763-588-7633