Provider Demographics
NPI:1982255345
Name:REST ASSURED LLC
Entity Type:Organization
Organization Name:REST ASSURED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-488-7199
Mailing Address - Street 1:4245 N OCOEE ST SUITE 4
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4999
Mailing Address - Country:US
Mailing Address - Phone:423-488-7199
Mailing Address - Fax:
Practice Address - Street 1:4245 N OCOEE ST SUITE 4
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4999
Practice Address - Country:US
Practice Address - Phone:423-488-7199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REST ASSURED LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-26
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies