=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487430864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESTORED LIFE HEALTH NETWORK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2023
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 S REED RD
-----------------------------------------------------
City | KOKOMO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46901-4900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-780-7689
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 S REED RD
-----------------------------------------------------
City | KOKOMO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46901-4900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-780-7689
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DAVID CHRISTENSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 765-780-7689
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------