Healthcare Provider Details

I. General information

NPI: 1497166722
Provider Name (Legal Business Name): RESTOREME M/H B/H SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WENTWORTH PL
HAMPTON VA
23666-1829
US

IV. Provider business mailing address

2 WENTWORTH PL
HAMPTON VA
23666-1829
US

V. Phone/Fax

Practice location:
  • Phone: 757-933-3837
  • Fax:
Mailing address:
  • Phone: 757-933-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral 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: TARNISHA CARTER
Title or Position: CEO
Credential:
Phone: 757-933-3837