Provider Demographics
NPI: | 1164743456 |
---|---|
Name: | RESTORATIVE NURSING SERVICES |
Entity Type: | Organization |
Organization Name: | RESTORATIVE NURSING SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | CHERYL |
Authorized Official - Middle Name: | DENISE |
Authorized Official - Last Name: | WILLIAMS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN, M ED |
Authorized Official - Phone: | 910-583-0264 |
Mailing Address - Street 1: | 111 LAMON ST STE 124 |
Mailing Address - Street 2: | |
Mailing Address - City: | FAYETTEVILLE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28301-4956 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 910-672-7043 |
Mailing Address - Fax: | 800-403-8236 |
Practice Address - Street 1: | 111 LAMON ST STE 124 |
Practice Address - Street 2: | |
Practice Address - City: | FAYETTEVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28301-4956 |
Practice Address - Country: | US |
Practice Address - Phone: | 910-672-7043 |
Practice Address - Fax: | 800-403-8236 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-06-21 |
Last Update Date: | 2011-11-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | HC4111 | 253Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 253Z00000X | Agencies | In Home Supportive Care |