Healthcare Provider Details

I. General information

NPI: 1396660627
Provider Name (Legal Business Name): RESTORATION COMMUNITY DEVELOPMENT ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 W SUNSET BLVD STE 204
SPOKANE WA
99224-1109
US

IV. Provider business mailing address

PO BOX 2581
SPOKANE WA
99220-2581
US

V. Phone/Fax

Practice location:
  • Phone: 509-279-3249
  • Fax:
Mailing address:
  • Phone: 509-279-3249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDRE DOVE
Title or Position: EXECUTIVE DIRECTOR
Credential: DR.
Phone: 509-279-3249