Provider Demographics
NPI:1922320324
Name:HOUSE OF RESTORATION
Entity Type:Organization
Organization Name:HOUSE OF RESTORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/ SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:CLIFTON
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:334-214-5522
Mailing Address - Street 1:1200 12TH CT
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-5732
Mailing Address - Country:US
Mailing Address - Phone:334-214-5522
Mailing Address - Fax:334-214-5525
Practice Address - Street 1:1200 12TH CT
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-5732
Practice Address - Country:US
Practice Address - Phone:334-214-5522
Practice Address - Fax:334-214-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty