Provider Demographics
NPI:1710766407
Name:RESTORED LIVING LLC
Entity Type:Organization
Organization Name:RESTORED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:OKPENZE
Authorized Official - Middle Name:FELICIA
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:917-378-2269
Mailing Address - Street 1:3044 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234
Mailing Address - Country:US
Mailing Address - Phone:917-378-2269
Mailing Address - Fax:410-882-1715
Practice Address - Street 1:8424 OLD HARFORD RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-4900
Practice Address - Country:US
Practice Address - Phone:917-378-2269
Practice Address - Fax:410-882-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health