Healthcare Provider Details

I. General information

NPI: 1508382557
Provider Name (Legal Business Name): RESTORER HOME HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 SANDMEYER LN STE 301
PHILADELPHIA PA
19116-3528
US

IV. Provider business mailing address

10065 SANDMEYER LN STE 301
PHILADELPHIA PA
19116-3528
US

V. Phone/Fax

Practice location:
  • Phone: 267-343-8505
  • Fax: 267-343-7976
Mailing address:
  • Phone: 267-343-8505
  • Fax: 267-343-7976

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: WALE DAVIS
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 267-343-8505