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General NPI Number Information
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NPI Number | 1447515457
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Entity Type | Organization
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Legal Business Name | THE RESTORATION CENTER
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 07/06/2012
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Provider Practice Location Address
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Address Line | 300 S 12TH ST
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City | NEWARK
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State | NJ
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Zip | 07103-1960
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Country | US
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Telephone | 973-622-4934
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Fax | 973-622-5820
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Provider Business Mailing Address
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Address Line | 300 S 12TH ST
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City | NEWARK
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State | NJ
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Zip | 07103-1960
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Country | US
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Telephone | 973-622-4934
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Fax | 973-622-5820
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. GWEN PARKS
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Credential |
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Telephone | 973-622-4934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 2000116
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License Number State | NJ
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