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General NPI Number Information
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NPI Number | 1245142454
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Entity Type | Organization
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Legal Business Name | RESTORATION VILLAGE
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 155 WILLOWBROOK BLVD STE 110 8659
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City | WAYNE
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State | NJ
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Zip | 07470-7032
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Country | US
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Telephone | 862-444-8443
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 117
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City | BEVERLY
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State | NJ
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Zip | 08010-0117
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Country | US
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Telephone | 862-444-8443
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | QUSTER BICAR
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Credential |
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Telephone | 862-444-8443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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