Provider Demographics
NPI:1558857888
Name:RESTORATION CRISIS CENTER THERAPEUTIC HOME
Entity Type:Organization
Organization Name:RESTORATION CRISIS CENTER THERAPEUTIC HOME
Other - Org Name:RESTORATION CRISIS CENTER THERAPEUTIC HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-525-9000
Mailing Address - Street 1:6808 JEFFERSON PAIGE RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-3302
Mailing Address - Country:US
Mailing Address - Phone:318-525-9000
Mailing Address - Fax:318-525-9007
Practice Address - Street 1:6808 JEFFERSON PAIGE RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-3302
Practice Address - Country:US
Practice Address - Phone:318-347-1963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16331322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children