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General NPI Number Information
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NPI Number | 1154362945
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Entity Type | Organization
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Legal Business Name | RESTORATION ODYSSEY INC
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 2814 ALDINE BENDER RD
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City | HOUSTON
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State | TX
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Zip | 77032-3502
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Country | US
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Telephone | 281-442-4900
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Fax | 281-442-4904
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Provider Business Mailing Address
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Address Line | PO BOX 111338
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City | HOUSTON
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State | TX
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Zip | 77293-0338
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Country | US
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Telephone | 281-442-4900
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Fax | 281-442-4904
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. GEORGE LOFTON GRANT
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Credential | LMSW,LCDC,LCCA
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Telephone | 281-442-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2303
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License Number State | TX
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