Provider Demographics
NPI:1942508221
Name:RESTORATIVE HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:RESTORATIVE HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSUTTI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:818-780-8110
Mailing Address - Street 1:111 BUCKLIN ST
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-2381
Mailing Address - Country:US
Mailing Address - Phone:815-780-8110
Mailing Address - Fax:815-780-8185
Practice Address - Street 1:111 BUCKLIN ST
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-2381
Practice Address - Country:US
Practice Address - Phone:815-780-8110
Practice Address - Fax:815-780-8185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011366251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health