NPIMap

Organization Active NPI

Restore LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fairbanks, AK
National Provider Identifier
1497424949
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
RESTORE LLC
Practice address
211 Cushman St
Fairbanks, AK 99701-4639
Phone
(907) 374-1097
NPI assigned
Sep 8, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Timothy M Thomas
Title
Chief Operations Officer
Phone
(907) 374-1097

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary
Substance Abuse Rehabilitation Facility 324500000X

Addresses

Primary practice location

211 Cushman St
Fairbanks, AK 99701-4639

Mailing address

PO Box 73004
Fairbanks, AK 99707-3004
Phone (907) 374-1097

Other identifiers 1

IdentifierTypeStateIssuer
1687081MedicaidAK

Other names 1

  • Refine Detoxification and Recovery Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Restore LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

211 Cushman St
Fairbanks, AK 99701
Phone (907) 328-1566

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728259200000",
    "number": "1497424949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73004",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997073004",
            "telephone_number": "907-374-1097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 CUSHMAN ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014639",
            "telephone_number": "907-374-1097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-08",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "907-374-1097"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1687081",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Refine Detoxification and Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Refine Detoxification and Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.