MEDICARE: RESTORING ALL PEOPLE SUPPORT CENTER LLC

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1801789383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORING ALL PEOPLE SUPPORT CENTER LLC

Provider Business Mailing Address
First Line	:	2641 BERMUDA LAKE DR APT 202A
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510-2488
Country	:	US
Telephone Number	:	813-970-4752
Fax Number	:	813-970-4752

Provider Business Practice Location Address
First Line	:	2641 BERMUDA LAKE DR APT 202A
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510-2488
Country	:	US
Telephone Number	:	813-970-4752
Fax Number	:	813-970-4752

Authorized Official
Title or Position	:	OWNER
Name	:	CAMERON CHASE WALDEN
Credential	:
Telephone Number	:	813-970-4752

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/03/2025

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