Provider Demographics
NPI:1487178166
Name:RESTORATION HOMES ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:RESTORATION HOMES ASSISTED LIVING FACILITY
Other - Org Name:CAYONNA M. MOORE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAYONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE-STRODDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-662-0550
Mailing Address - Street 1:135 MANSEAU DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1719
Mailing Address - Country:US
Mailing Address - Phone:863-875-4961
Mailing Address - Fax:863-229-7186
Practice Address - Street 1:135 MANSEAU DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-1719
Practice Address - Country:US
Practice Address - Phone:863-875-4961
Practice Address - Fax:863-229-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014960000Medicaid