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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