Provider Demographics
NPI:1689096844
Name:RESTORATION HOME CARE AGENCY
Entity Type:Organization
Organization Name:RESTORATION HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-223-7707
Mailing Address - Street 1:6905 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-7895
Mailing Address - Country:US
Mailing Address - Phone:910-223-7707
Mailing Address - Fax:910-223-7707
Practice Address - Street 1:6905 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312-7895
Practice Address - Country:US
Practice Address - Phone:910-223-7707
Practice Address - Fax:910-223-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health