Provider Demographics
NPI:1033264544
Name:RESTORATION CENTER INC
Entity Type:Organization
Organization Name:RESTORATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:SUBSTANCE ABUSE COUN
Authorized Official - Phone:785-341-9499
Mailing Address - Street 1:122 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6110
Mailing Address - Country:US
Mailing Address - Phone:785-537-8809
Mailing Address - Fax:785-537-8850
Practice Address - Street 1:235 W 7TH ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-3594
Practice Address - Country:US
Practice Address - Phone:785-762-4470
Practice Address - Fax:785-762-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200367480 GMedicaid
KS200367480AMedicaid