Provider Demographics
NPI:1740002369
Name:RESTORE LYFE LLC
Entity type:Organization
Organization Name:RESTORE LYFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS
Authorized Official - Phone:520-709-9163
Mailing Address - Street 1:22 CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-4622
Mailing Address - Country:US
Mailing Address - Phone:571-501-7151
Mailing Address - Fax:
Practice Address - Street 1:22 CHADWICK DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-4622
Practice Address - Country:US
Practice Address - Phone:571-501-7151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health