Provider Demographics
NPI:1043838014
Name:RESTORATION DME SUPPLIES, LLC
Entity Type:Organization
Organization Name:RESTORATION DME SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-872-4405
Mailing Address - Street 1:326 N MULBERRY ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1880
Mailing Address - Country:US
Mailing Address - Phone:270-872-4405
Mailing Address - Fax:270-872-4403
Practice Address - Street 1:326 N MULBERRY ST STE 105
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1880
Practice Address - Country:US
Practice Address - Phone:270-872-4405
Practice Address - Fax:270-872-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies