Healthcare Provider Details

I. General information

NPI: 1255816401
Provider Name (Legal Business Name): RESTORATION CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 NORTHWESTERN PKWY
LOUISVILLE KY
40212-1029
US

IV. Provider business mailing address

3803 MIAMI AVE
LOUISVILLE KY
40212-2915
US

V. Phone/Fax

Practice location:
  • Phone: 502-835-3052
  • Fax:
Mailing address:
  • Phone: 502-835-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DENISE GOLDSMITH-KELLEY
Title or Position: CEO/DIRECTOR
Credential:
Phone: 502-835-3052