Provider Demographics
NPI:1003118670
Name:RESTORATION HOME CARE SERVICES INC.
Entity Type:Organization
Organization Name:RESTORATION HOME CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MAYFIELD
Authorized Official - Last Name:SHERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-325-3814
Mailing Address - Street 1:410 1ST AVE S STE 3
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-2704
Mailing Address - Country:US
Mailing Address - Phone:704-325-3814
Mailing Address - Fax:704-325-3812
Practice Address - Street 1:410 1ST AVE S STE 3
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-2704
Practice Address - Country:US
Practice Address - Phone:704-325-3814
Practice Address - Fax:704-325-3812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3970251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601998Medicaid