Healthcare Provider Details

I. General information

NPI: 1467377937
Provider Name (Legal Business Name): RESTORE HEALTH AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9026 HARRATT ST
WEST HOLLYWOOD CA
90069-3804
US

IV. Provider business mailing address

6918 OWENSMOUTH AVE
CANOGA PARK CA
91303-2003
US

V. Phone/Fax

Practice location:
  • Phone: 818-946-2772
  • Fax:
Mailing address:
  • Phone: 818-946-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ERIC J LEON
Title or Position: COO
Credential:
Phone: 954-641-5366