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General NPI Number Information
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NPI Number | 1073749693
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Entity Type | Organization
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Legal Business Name | RESTART INC. ROCKY MT
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 301 S CHURCH ST
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-5755
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Country | US
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Telephone | 252-442-1359
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Fax |
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Provider Business Mailing Address
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Address Line | 2602 COURTIER DR
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City | GREENVILLE
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State | NC
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Zip | 27834-7818
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DENNIS MITCHELL
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Credential |
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Telephone | 252-355-4725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 8301850
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License Number State | NC
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