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General NPI Number Information
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NPI Number | 1043030257
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Entity Type | Organization
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Legal Business Name | RESTORED HOMECARE LLC
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 5041 NORTHERN LIGHTS DR
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City | GREENACRES
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State | FL
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Zip | 33463-5937
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Country | US
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Telephone | 561-779-1522
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Fax | 561-516-7270
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Provider Business Mailing Address
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Address Line | 5041 NORTHERN LIGHTS DR
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City | GREENACRES
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State | FL
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Zip | 33463-5937
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Country | US
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Telephone | 561-779-1522
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Fax |
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Authorized Official
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Title or Position | MANAGE
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Name | FISELA CHARLES
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Credential | RN
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Telephone | 561-779-1522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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