Healthcare Provider Details

I. General information

NPI: 1073749693
Provider Name (Legal Business Name): RESTART INC. ROCKY MT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S CHURCH ST
ROCKY MOUNT NC
27804-5755
US

IV. Provider business mailing address

2602 COURTIER DR
GREENVILLE NC
27834-7818
US

V. Phone/Fax

Practice location:
  • Phone: 252-442-1359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number8301850
License Number StateNC

VIII. Authorized Official

Name: MR. DENNIS MITCHELL
Title or Position: CEO
Credential:
Phone: 252-355-4725