Provider Demographics
NPI:1558997296
Name:RESTORATION BEHAVIORAL HEALTH SYSTEMS,LLC
Entity Type:Organization
Organization Name:RESTORATION BEHAVIORAL HEALTH SYSTEMS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-982-6355
Mailing Address - Street 1:5430 CAMPBELL BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-5503
Mailing Address - Country:US
Mailing Address - Phone:410-982-6355
Mailing Address - Fax:
Practice Address - Street 1:3455 WILKENS AVE STE 100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5204
Practice Address - Country:US
Practice Address - Phone:410-982-6355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1911009191OtherBEHAVIORAL HEALTH IOP NUMBER