NPIMap

Organization Active NPI

Restore LLC

  • Substance Abuse Rehabilitation Facility
  • Fairbanks, AK
National Provider Identifier
1881210474
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
RESTORE LLC
Practice address
1095 Tena Ave
Fairbanks, AK 99701-1422
Phone
(907) 374-1097
Fax
(907) 374-1062
NPI assigned
Jun 19, 2020
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

1095 Tena Ave
Fairbanks, AK 99701-1422

Mailing address

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

Other practice location 1

542 4th Ave Ste B-101
Fairbanks, AK 99701-4707
Phone (907) 374-1097 ext. 90775

Other identifiers 1

IdentifierTypeStateIssuer
1709994MedicaidAK

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.

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": "1592524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728259200000",
    "number": "1881210474",
    "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",
            "fax_number": "907-374-1062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 TENA AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997011422",
            "telephone_number": "907-374-1097",
            "fax_number": "907-374-1062"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "542 4th Ave Ste B-101",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997014707",
            "country_code": "US",
            "telephone_number": "907-374-1097 x90775",
            "fax_number": "907-374-1062",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RESTORE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-19",
        "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": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1709994",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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.