Active NPI
Restored Life Health Network
- Multi-Specialty Clinic/Center
- Kokomo, IN
National Provider Identifier
1487430864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Multi-Specialty Clinic/Center
- Legal business name
- RESTORED LIFE HEALTH NETWORK
- Practice address
- 302 S Reed Rd
Kokomo, IN 46901-4900 - Phone
- (765) 780-7689
- NPI assigned
- Sep 1, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- David Christenson
- Title
- Executive Director
- Phone
- (765) 780-7689
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | Primary |
Addresses
Primary practice location
302 S Reed Rd
Kokomo, IN 46901-4900
Mailing address
302 S Reed Rd
Kokomo, IN 46901-4900
Phone (765) 780-7689
Other practice location 1
1236 N Wabash Ave
Kokomo, IN 46901-2604
Phone (765) 780-7689
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15D2330360 | Other | CA | CMS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231229001923 | IN | Part B Supplier - Clinic/Group Practice | 3173973336 |
Receives reassigned benefits from 9 practitioners Practice locations: Kokomo, IN |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2330360 | Restored Life Health Network | Registration | Sep 14, 2027 |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 10
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Clinical Social Worker
- Kokomo, IN
- NPI 1467096339
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693526400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1764633600000",
"number": "1487430864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "302 S REED RD",
"city": "KOKOMO",
"state": "IN",
"postal_code": "469014900",
"telephone_number": "765-780-7689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "302 S REED RD",
"city": "KOKOMO",
"state": "IN",
"postal_code": "469014900",
"telephone_number": "765-780-7689"
}
],
"practiceLocations": [
{
"address_1": "1236 N Wabash Ave",
"address_purpose": "LOCATION",
"city": "Kokomo",
"state": "IN",
"postal_code": "469012604",
"country_code": "US",
"telephone_number": "765-780-7689",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "RESTORED LIFE HEALTH NETWORK",
"organizational_subpart": "NO",
"enumeration_date": "2023-09-01",
"last_updated": "2025-12-02",
"certification_date": "2025-12-02",
"status": "A",
"authorized_official_last_name": "CHRISTENSON",
"authorized_official_first_name": "DAVID",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "765-780-7689"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CMS",
"identifier": "15D2330360",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kokomo, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.