Provider Demographics
NPI:1912414129
Name:RESTORED INDEPENDENCE HOMECARE LLC
Entity Type:Organization
Organization Name:RESTORED INDEPENDENCE HOMECARE LLC
Other - Org Name:RESTORED INDEPENDENCE HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAMEKA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-712-1286
Mailing Address - Street 1:300 2ND AVE NE STE 224
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-3373
Mailing Address - Country:US
Mailing Address - Phone:701-248-4232
Mailing Address - Fax:701-248-4233
Practice Address - Street 1:300 2ND AVE NE STE 224
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-3373
Practice Address - Country:US
Practice Address - Phone:701-248-4232
Practice Address - Fax:701-248-4233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1473354Medicaid