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General NPI Number Information
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NPI Number | 1609593821
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Entity Type | Organization
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Legal Business Name | RESTORE LLC
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 513 12TH AVE
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City | FAIRBANKS
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State | AK
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Zip | 99701-4910
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Country | US
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Telephone | 907-374-1097
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 73004
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City | FAIRBANKS
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State | AK
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Zip | 99707-3004
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Country | US
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Telephone | 907-374-1097
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | TIMOTHY M THOMAS
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Credential |
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Telephone | 907-374-1097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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