Provider Demographics
NPI:1649272113
Name:RESTORA HOME HEALTH, INC.
Entity type:Organization
Organization Name:RESTORA HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:V
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-533-0367
Mailing Address - Street 1:1317 W. FOOTHILL BLVD.
Mailing Address - Street 2:SUITE 130
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3684
Mailing Address - Country:US
Mailing Address - Phone:909-931-0710
Mailing Address - Fax:909-931-0395
Practice Address - Street 1:1317 W. FOOTHILL BLVD.
Practice Address - Street 2:SUITE 130
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3684
Practice Address - Country:US
Practice Address - Phone:909-931-0710
Practice Address - Fax:909-931-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000707251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08029FMedicaid
CAHHA08029FMedicaid