Provider Demographics
NPI:1003331752
Name:RESTORATIVE OUTDOOR SERVICES LLC
Entity Type:Organization
Organization Name:RESTORATIVE OUTDOOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:NIEMI
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CBIS
Authorized Official - Phone:231-714-4450
Mailing Address - Street 1:6874 WILDWOOD TRL SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOARDMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49680-9588
Mailing Address - Country:US
Mailing Address - Phone:231-714-4450
Mailing Address - Fax:
Practice Address - Street 1:6874 WILDWOOD TRL SW
Practice Address - Street 2:
Practice Address - City:SOUTH BOARDMAN
Practice Address - State:MI
Practice Address - Zip Code:49680-9588
Practice Address - Country:US
Practice Address - Phone:231-714-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty