Provider Demographics
NPI:1972349348
Name:RESTORATIVE ENTERPRISES LLC
Entity type:Organization
Organization Name:RESTORATIVE ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NAPOLEON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CROWELL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:704-975-1727
Mailing Address - Street 1:4711 OLD CHARLOTTE HWY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-7338
Mailing Address - Country:US
Mailing Address - Phone:704-975-1727
Mailing Address - Fax:
Practice Address - Street 1:4711 OLD CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-7338
Practice Address - Country:US
Practice Address - Phone:704-975-1727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health