Provider Demographics
NPI:1518514777
Name:RESTORED LIVING INC
Entity Type:Organization
Organization Name:RESTORED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OKPENZE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-882-1715
Mailing Address - Street 1:8424 OLD HARFORD RD STE 3C
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-4900
Mailing Address - Country:US
Mailing Address - Phone:410-882-1715
Mailing Address - Fax:
Practice Address - Street 1:8424 OLD HARFORD RD STE 3C
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-4900
Practice Address - Country:US
Practice Address - Phone:410-882-1715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty