Healthcare Provider Details

I. General information

NPI: 1275338998
Provider Name (Legal Business Name): RESTORING FAITH, HOME & HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 WILD POPLAR WAY
GREENSBORO NC
27405-2951
US

IV. Provider business mailing address

2830 WILD POPLAR WAY
GREENSBORO NC
27405-2951
US

V. Phone/Fax

Practice location:
  • Phone: 336-255-4473
  • Fax: 336-500-8328
Mailing address:
  • Phone: 336-255-4473
  • Fax: 336-500-8328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DOMINIQUE RAYSHAWN WILLIAMS
Title or Position: CEO
Credential:
Phone: 336-255-4473