Provider Demographics
NPI:1811624786
Name:RESTORATION BEHAVIORAL HEALTH SYSTEMS,LLC
Entity type:Organization
Organization Name:RESTORATION BEHAVIORAL HEALTH SYSTEMS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-982-6355
Mailing Address - Street 1:5430 CAMPBELL BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-5503
Mailing Address - Country:US
Mailing Address - Phone:410-982-6355
Mailing Address - Fax:
Practice Address - Street 1:5430 CAMPBELL BLVD STE 107
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162-5503
Practice Address - Country:US
Practice Address - Phone:410-982-6355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health