Provider Demographics
NPI:1821879156
Name:RESTORATION COMMUNITY DEVELOPMENT CORP.
Entity Type:Organization
Organization Name:RESTORATION COMMUNITY DEVELOPMENT CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-303-1800
Mailing Address - Street 1:308 CAMELLIA LN
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-2604
Mailing Address - Country:US
Mailing Address - Phone:662-303-1800
Mailing Address - Fax:662-399-5101
Practice Address - Street 1:500 CC ROAD
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038
Practice Address - Country:US
Practice Address - Phone:662-303-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESTORATION COMMUNITY DEVELOPMENT CORP FACILITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility