Provider Demographics
NPI:1750327730
Name:RESTORE HEALTHCARE SERVICES,INC.
Entity Type:Organization
Organization Name:RESTORE HEALTHCARE SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TITUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:EGBEJIMI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-248-5866
Mailing Address - Street 1:9900 WESTPARK DR
Mailing Address - Street 2:SUITE #365
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-5277
Mailing Address - Country:US
Mailing Address - Phone:713-248-5866
Mailing Address - Fax:713-726-0220
Practice Address - Street 1:9900 WESTPARK DR
Practice Address - Street 2:SUITE #365
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5277
Practice Address - Country:US
Practice Address - Phone:713-248-5866
Practice Address - Fax:713-726-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009741251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677936Medicare ID - Type Unspecified