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General NPI Number Information
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NPI Number | 1376208611
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Entity Type | Organization
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Legal Business Name | RESTORATION RECOVERY
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 80 RUTLAND ST
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City | DOVER
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State | NH
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Zip | 03820-3905
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Country | US
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Telephone | 603-512-3866
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1664
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City | DOVER
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State | NH
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Zip | 03821-1664
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Country | US
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Telephone | 603-343-2560
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NATHAN GAGNE
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Credential |
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Telephone | 603-512-3866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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