Provider Demographics
NPI:1235567918
Name:RESTORATION OF THE MINDS LLC
Entity Type:Organization
Organization Name:RESTORATION OF THE MINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, FOUNDER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATRICK-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-881-3563
Mailing Address - Street 1:1408 EDGERLY AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-4302
Mailing Address - Country:US
Mailing Address - Phone:229-881-3563
Mailing Address - Fax:
Practice Address - Street 1:1408 EDGERLY AVENUE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707
Practice Address - Country:US
Practice Address - Phone:229-881-3563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health