Provider Demographics
NPI:1417276494
Name:RESTORED LIVING HEALTHCARE, INC
Entity Type:Organization
Organization Name:RESTORED LIVING HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHIVON
Authorized Official - Middle Name:DARNICE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:281-990-8931
Mailing Address - Street 1:15011 COBRE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2809
Mailing Address - Country:US
Mailing Address - Phone:281-990-8931
Mailing Address - Fax:281-286-5945
Practice Address - Street 1:15011 COBRE VALLEY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2809
Practice Address - Country:US
Practice Address - Phone:281-990-8931
Practice Address - Fax:281-286-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-29
Last Update Date:2010-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012507251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health