1225200793 NPI number — RESTORATIVE HEALTH SERVICES, INC.

Table of content: TIFFANY LUANA FLORES MA, LMFT (NPI 1013435650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225200793 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:
1225200793
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 305172
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:
37230-5172
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:
205 OAK PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC MINNVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37110-1336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-507-9900
Provider Business Practice Location Address Fax Number:
931-507-9903
Provider Enumeration Date:
03/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SORENSEN
Authorized Official First Name:
AARON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
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 TN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1455196 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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