1043275266 NPI number — RESTORATIVE HEALTH SERVICES, INC

Table of content: (NPI 1043275266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043275266 NPI number — RESTORATIVE HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESTORATIVE HEALTH SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043275266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 440104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37244-0104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-217-9821
Provider Business Mailing Address Fax Number:
615-217-9828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1272 GARRISON DR
Provider Second Line Business Practice Location Address:
STE. 307
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37129-2570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-890-2160
Provider Business Practice Location Address Fax Number:
615-890-2361
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SORENSEN
Authorized Official First Name:
AARON
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER PRACTITIONER
Authorized Official Telephone Number:
615-890-2160

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4001463 . This is a "BCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1454472 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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