Provider Demographics
NPI:1679236376
Name:RESTORATION THERAPY WITH FALAYA DESILVA LLC
Entity Type:Organization
Organization Name:RESTORATION THERAPY WITH FALAYA DESILVA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FALAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESILVA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:562-676-3502
Mailing Address - Street 1:3938 E CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3827
Mailing Address - Country:US
Mailing Address - Phone:562-676-3502
Mailing Address - Fax:
Practice Address - Street 1:3938 E CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-3827
Practice Address - Country:US
Practice Address - Phone:562-676-3502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health