Provider Demographics
NPI:1710720321
Name:R.E.S.T.O.R.E
Entity type:Organization
Organization Name:R.E.S.T.O.R.E
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-997-4661
Mailing Address - Street 1:3509 INTERSTATE BLVD S STE 100
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2200
Mailing Address - Country:US
Mailing Address - Phone:701-239-0078
Mailing Address - Fax:
Practice Address - Street 1:3509 INTERSTATE BLVD S STE 100
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2200
Practice Address - Country:US
Practice Address - Phone:701-239-0078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management