Provider Demographics
NPI:1639615537
Name:RESTORE U INC.
Entity Type:Organization
Organization Name:RESTORE U INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:ISLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ST.VIL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LCSW
Authorized Official - Phone:813-495-6702
Mailing Address - Street 1:3005 LITHIA PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-5630
Mailing Address - Country:US
Mailing Address - Phone:813-495-6702
Mailing Address - Fax:813-425-5739
Practice Address - Street 1:3005 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-5630
Practice Address - Country:US
Practice Address - Phone:813-495-6702
Practice Address - Fax:813-425-5739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 13121251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017869000Medicaid