Organization
RESTORE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY M THOMAS (CHIEF OPERATIONS OFFICER)
(907) 374-1097
Entity
Organization
Contact information
Practice address
1095 TENA AVE, FAIRBANKS, AK 99701-1422
(907) 374-1097
(907) 374-1062
Mailing address
PO BOX 73004, FAIRBANKS, AK 99707-3004
(907) 374-1097
(907) 374-1062
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1709994
—
AK
Enumeration date
06/19/2020
Last updated
10/07/2024
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