=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720566029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RELATE RESTORE REPAIR, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2018
-----------------------------------------------------
Last Update Date | 12/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7435 E PEAKVIEW AVE
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-6703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-443-3854
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7435 E PEAKVIEW AVE
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-6703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-443-3854
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | STACEY MACGLASHAN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 720-443-3854
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------