MEDICARE: THE RESTORATION CENTER

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	261QM0850X	Adult Mental Health Clinic/Center	2000116	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447515457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE RESTORATION CENTER

Provider Business Mailing Address
First Line	:	300 S 12TH ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-1960
Country	:	US
Telephone Number	:	973-622-4934
Fax Number	:	973-622-5820

Provider Business Practice Location Address
First Line	:	300 S 12TH ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-1960
Country	:	US
Telephone Number	:	973-622-4934
Fax Number	:	973-622-5820

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. GWEN PARKS
Credential	:
Telephone Number	:	973-622-4934

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	07/06/2012

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Directions to “THE RESTORATION CENTER ” Practice Location

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