Provider Demographics
NPI:1902382625
Name:RESTORED THROUGH GRACE, LLC
Entity Type:Organization
Organization Name:RESTORED THROUGH GRACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:BENOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-934-7638
Mailing Address - Street 1:2332 CLUBSIDE CT APT 1422
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1782
Mailing Address - Country:US
Mailing Address - Phone:305-934-7638
Mailing Address - Fax:
Practice Address - Street 1:2332 CLUBSIDE CT
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1782
Practice Address - Country:US
Practice Address - Phone:305-934-7638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FLSW14827261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty