Provider Demographics
NPI:1659801074
Name:RESTORED LLC
Entity Type:Organization
Organization Name:RESTORED LLC
Other - Org Name:LICE CLINIC OF AMERICA BIRMINGHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-783-5423
Mailing Address - Street 1:3118 BELWOOD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5264
Mailing Address - Country:US
Mailing Address - Phone:205-783-5423
Mailing Address - Fax:
Practice Address - Street 1:3118 BELWOOD DR STE 102
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-5264
Practice Address - Country:US
Practice Address - Phone:205-783-5423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty