Provider Demographics
NPI:1366219511
Name:RESTORATION HEALTHCARE SERVICES,INC
Entity type:Organization
Organization Name:RESTORATION HEALTHCARE SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MBAH
Authorized Official - Last Name:METUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-476-9997
Mailing Address - Street 1:1806 SUMMIT AVE STE 131
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4339
Mailing Address - Country:US
Mailing Address - Phone:240-476-9997
Mailing Address - Fax:
Practice Address - Street 1:3900 WESTERRE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1339
Practice Address - Country:US
Practice Address - Phone:540-406-3072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty