Provider Demographics
NPI:1760289292
Name:RESTORECARE
Entity type:Organization
Organization Name:RESTORECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAHJO
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAHAMUD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-703-7465
Mailing Address - Street 1:1965 COUNTY ROAD E W
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-7145
Mailing Address - Country:US
Mailing Address - Phone:612-703-7465
Mailing Address - Fax:
Practice Address - Street 1:1965 COUNTY ROAD E W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-7145
Practice Address - Country:US
Practice Address - Phone:612-703-7465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care