Provider Demographics
NPI: | 1346805017 |
---|---|
Name: | NEW RESTORATION MINISTRIES |
Entity Type: | Organization |
Organization Name: | NEW RESTORATION MINISTRIES |
Other - Org Name: | NEW REST COMMUNITY HEALTH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | LAMON |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | WHITE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 443-392-8191 |
Mailing Address - Street 1: | 2037 W NORTH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | BALTIMORE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21217-1221 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2037 W NORTH AVE |
Practice Address - Street 2: | |
Practice Address - City: | BALTIMORE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21217-1221 |
Practice Address - Country: | US |
Practice Address - Phone: | 443-392-8191 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-05-07 |
Last Update Date: | 2019-11-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |
No | 251B00000X | Agencies | Case Management | ||
No | 251K00000X | Agencies | Public Health or Welfare | ||
No | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 251V00000X | Agencies | Voluntary or Charitable | ||
No | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | ||
No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | ||
No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 1 | Medicaid |