Provider Demographics
NPI:1689497141
Name:RESTORE HEALTH COLLABORATIVE PLLC
Entity type:Organization
Organization Name:RESTORE HEALTH COLLABORATIVE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:641-619-5154
Mailing Address - Street 1:1119 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1200
Mailing Address - Country:US
Mailing Address - Phone:641-619-5154
Mailing Address - Fax:641-230-9082
Practice Address - Street 1:1119 E 2ND ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1200
Practice Address - Country:US
Practice Address - Phone:641-619-5154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1972808079Medicaid