Provider Demographics
NPI:1174223473
Name:RESTORE RECOVERY
Entity type:Organization
Organization Name:RESTORE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDE T
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:PRSS
Authorized Official - Phone:651-724-2860
Mailing Address - Street 1:139 HILL ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:MN
Mailing Address - Zip Code:55363-8597
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:139 HILL ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MN
Practice Address - Zip Code:55363-8597
Practice Address - Country:US
Practice Address - Phone:651-724-2860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty