Provider Demographics
NPI:1679012314
Name:RESTORATION HOME CARE INC.
Entity Type:Organization
Organization Name:RESTORATION HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:AWAKAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-735-5811
Mailing Address - Street 1:552 E 44TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3466
Mailing Address - Country:US
Mailing Address - Phone:312-735-5811
Mailing Address - Fax:
Practice Address - Street 1:552 E 44TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3466
Practice Address - Country:US
Practice Address - Phone:312-735-5811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3001336253Z00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3001336Other3001336