Provider Demographics
NPI:1790350015
Name:RESTORE 360 LLC
Entity Type:Organization
Organization Name:RESTORE 360 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUWASEYI
Authorized Official - Middle Name:
Authorized Official - Last Name:EFFRAIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-373-2710
Mailing Address - Street 1:600 STETSON RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2525
Mailing Address - Country:US
Mailing Address - Phone:510-504-4138
Mailing Address - Fax:
Practice Address - Street 1:7516 CITY AVE STE 7&8
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2102
Practice Address - Country:US
Practice Address - Phone:484-373-2710
Practice Address - Fax:484-373-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty