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General NPI Number Information
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NPI Number | 1184138935
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Entity Type | Organization
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Legal Business Name | RESTORATIVE HEALTH WELLNESS CENTER
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 2327 PANSY ST SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3804
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Country | US
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Telephone | 256-520-2351
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Fax | 256-429-9807
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Provider Business Mailing Address
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Address Line | 1101 CHESTNUT RD NW
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City | HUNTSVILLE
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State | AL
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Zip | 35816-2309
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Country | US
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Telephone | 256-520-2351
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Fax | 256-429-9807
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELINE ANN MALONE
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Credential | RN
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Telephone | 256-520-2351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4577
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License Number State | AL
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