Provider Demographics
NPI:1811320880
Name:RESTORING BODIES AND MINDS, LLC
Entity type:Organization
Organization Name:RESTORING BODIES AND MINDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:SHAVONE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BA, AAS
Authorized Official - Phone:252-820-0652
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:TOWNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27584-0101
Mailing Address - Country:US
Mailing Address - Phone:252-820-0652
Mailing Address - Fax:252-572-2492
Practice Address - Street 1:945 W ANDREWS AVE STE F
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2504
Practice Address - Country:US
Practice Address - Phone:252-572-2392
Practice Address - Fax:252-572-2492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESTORING BODIES AND MINDS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health