=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003777475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESTORED HOME HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2025
-----------------------------------------------------
Last Update Date | 11/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 593 N OVERLOOK TRL
-----------------------------------------------------
City | ROUND LAKE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60073-8121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-540-5322
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 593 N OVERLOOK TRL
-----------------------------------------------------
City | ROUND LAKE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60073-8121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-540-5322
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATION
-----------------------------------------------------
Name | ROTIMI ADEJOLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-603-1940
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------