Provider Demographics
NPI:1679027858
Name:RESTORE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:RESTORE HEALTH SERVICES INC
Other - Org Name:RESTORE HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-508-5915
Mailing Address - Street 1:4400 N HIGHWAY 19A STE 9
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2022
Mailing Address - Country:US
Mailing Address - Phone:352-589-0357
Mailing Address - Fax:
Practice Address - Street 1:4400 N HIGHWAY 19A STE 9
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2022
Practice Address - Country:US
Practice Address - Phone:352-589-0357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104831100Medicaid
FLPENDINGOtherPENDING