MEDICARE: RESTORATION ODYSSEY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	2303	TX

General Provider Information

NPI Number	:	1154362945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATION ODYSSEY INC

Provider Business Mailing Address
First Line	:	PO BOX 111338
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77293-0338
Country	:	US
Telephone Number	:	281-442-4900
Fax Number	:	281-442-4904

Provider Business Practice Location Address
First Line	:	2814 ALDINE BENDER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77032-3502
Country	:	US
Telephone Number	:	281-442-4900
Fax Number	:	281-442-4904

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. GEORGE LOFTON GRANT
Credential	:	LMSW,LCDC,LCCA
Telephone Number	:	281-442-4900

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	02/12/2008

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