Provider Demographics
NPI:1336920602
Name:RESTORATION HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:RESTORATION HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUB-ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUWANIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KEYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-748-0307
Mailing Address - Street 1:12201 W NORTH AVE STE 102A
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2061
Mailing Address - Country:US
Mailing Address - Phone:414-210-3555
Mailing Address - Fax:
Practice Address - Street 1:12201 W NORTH AVE STE 102A
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2061
Practice Address - Country:US
Practice Address - Phone:414-210-3555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care