Restoration Lab Services LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

RESTORATION LAB SERVICES LLC

Practice address

3805 Washington Ave N
Minneapolis, MN 55412-2141

Phone

(612) 677-2668

Fax

(612) 767-6603

NPI assigned

Apr 20, 2017

Last updated

Oct 18, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Robin McKernan, B.S.

Title

Chief Compliance Officer

Phone

(612) 767-9525

Specialties & licenses 1

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Paul Anthony Kustermann

  • Contractor
  • Apple Valley, MN
  • NPI 1700162518
  NPD
• Nichole Marie Cardinal, BA, LADC

  • Addiction (Substance Use Disorder) Counselor
  • Minneapolis, MN
  • NPI 1396153128
  NPD (past)
• Shelly Kuiper, LADC

  • Addiction (Substance Use Disorder) Counselor
  • Minneapolis, MN
  • NPI 1205244282
  NPD (past)
• Aziza Marshall, B.A., LADC

  • Addiction (Substance Use Disorder) Counselor
  • Minneapolis, MN
  • NPI 1083021034
  NPD (past)

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

{
    "created_epoch": "1492646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508284800000",
    "number": "1548794175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3805 WASHINGTON AVENUE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554121714",
            "telephone_number": "612-767-9525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805 WASHINGTON AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554122141",
            "telephone_number": "612-677-2668",
            "fax_number": "612-767-6603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORATION LAB SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-20",
        "last_updated": "2017-10-18",
        "status": "A",
        "authorized_official_last_name": "MCKERNAN",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "612-767-9525",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "B.S."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Resource, Inc. (Spectrum Community Mental Health)
• Resource, Inc. (Minnesota Resource Center)
• Resource, Inc. (Minnesota Resource Center)
• Resource, Inc. (Spectrum Community Mental Health)
• Restoration Counseling & Community Services, LLC
• Isabella Restrepo Toro
• Resurge Treatment Services, LLC
• Alain Lebita Ret, MD
• Retina Center PA (Retina Center of Minnesota)
• Cathleen Marie Retka, LPN

• Clinical Medical Laboratory in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Medical Laboratory in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; 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.