Provider Demographics
NPI:1376038042
Name:RESTORATION CARE SERVICES, LLC
Entity Type:Organization
Organization Name:RESTORATION CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DENISE SMITH
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:SITTER/COMPANION
Authorized Official - Phone:229-269-2294
Mailing Address - Street 1:PO BOX 4116
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604-4116
Mailing Address - Country:US
Mailing Address - Phone:229-269-2294
Mailing Address - Fax:
Practice Address - Street 1:704 LAKE PARK ROAD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601
Practice Address - Country:US
Practice Address - Phone:229-269-2294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA092-R-1862251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health