Provider Demographics
NPI:1235130881
Name:RESTORATION MINISTRIES, INTERNATIONAL
Entity Type:Organization
Organization Name:RESTORATION MINISTRIES, INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR/COUNSELOR/TEACHE
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:303-753-6677
Mailing Address - Street 1:2755 S LOCUST ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7126
Mailing Address - Country:US
Mailing Address - Phone:303-753-6677
Mailing Address - Fax:303-753-6868
Practice Address - Street 1:2755 S LOCUST ST
Practice Address - Street 2:SUITE 209
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7126
Practice Address - Country:US
Practice Address - Phone:303-753-6677
Practice Address - Fax:303-753-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8762261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO524418Medicare ID - Type UnspecifiedGRP#
CO524438Medicare PIN