MEDICARE: RESTORATION HOME 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1285951509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATION HOME INC.

Provider Business Mailing Address
First Line	:	1313 E 11TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-4116
Country	:	US
Telephone Number	:	850-763-1341
Fax Number	:	850-747-9029

Provider Business Practice Location Address
First Line	:	1313 E 11TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-4116
Country	:	US
Telephone Number	:	850-763-1341
Fax Number	:	850-747-9029

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. CARLA HIGHTOWER
Credential	:
Telephone Number	:	850-763-1341

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	04/26/2010

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