Provider Demographics
NPI:1255664355
Name:RESTORE LIFE HOME CARE LLC
Entity Type:Organization
Organization Name:RESTORE LIFE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTUGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-233-5056
Mailing Address - Street 1:1932 COLOGNE AVE
Mailing Address - Street 2:L-1
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2441
Mailing Address - Country:US
Mailing Address - Phone:609-233-5056
Mailing Address - Fax:
Practice Address - Street 1:1932 COLOGNE AVE
Practice Address - Street 2:L-1
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2441
Practice Address - Country:US
Practice Address - Phone:609-233-5056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01095400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty