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Organization
RESTORE HEALTHCARE MEDICAL GROUP
Active
Organization
RESTORE HEALTHCARE MEDICAL GROUP
Active
Other names
Restore Healthcare Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA JARRETT (EXECUTIVE DIRECTOR)
(704) 559-9409
Entity
Organization
Contact information
Practice address
330 CAMP RD STE B43, CHARLOTTE, NC 28206-4005
(888) 661-7730
(888) 813-2442
Mailing address
2764 PLEASANT RD STE 10134, FORT MILL, SC 29708-7213
(888) 661-7730
(888) 813-2442
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
208000000X
Pediatrics Physician
—
—
224ZE0001X
Environmental Modification Occupational Therapy Assistant
—
—
235Z00000X
Speech-Language Pathologist
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
=========
MANAGED CARE PROVIDER INSURANCE
—
05
—
=========
—
NC
05
—
=========
—
SC
Enumeration date
04/03/2018
Last updated
10/28/2021
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