Provider Demographics
NPI:1891934956
Name:RESTORATION WORLD OUTREACH 1 INC.
Entity Type:Organization
Organization Name:RESTORATION WORLD OUTREACH 1 INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIWANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-710-4129
Mailing Address - Street 1:1211 S WESTERN AVE
Mailing Address - Street 2:LL101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1151
Mailing Address - Country:US
Mailing Address - Phone:773-710-4129
Mailing Address - Fax:
Practice Address - Street 1:1211 SOUTH WESTERN AVE
Practice Address - Street 2:LL101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1151
Practice Address - Country:US
Practice Address - Phone:773-710-4129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies