Provider Demographics
NPI:1790377919
Name:RESTFUL HOME LLC
Entity Type:Organization
Organization Name:RESTFUL HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LENG
Authorized Official - Middle Name:
Authorized Official - Last Name:XIONG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:612-618-2918
Mailing Address - Street 1:2120 11TH AVE E
Mailing Address - Street 2:
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5147
Mailing Address - Country:US
Mailing Address - Phone:651-747-6336
Mailing Address - Fax:
Practice Address - Street 1:1615 SLOAN ST APT 5
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-3096
Practice Address - Country:US
Practice Address - Phone:612-618-2918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency