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General NPI Number Information
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NPI Number | 1487178166
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Entity Type | Organization
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Legal Business Name | RESTORATION HOMES ASSISTED LIVING FACILITY
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 135 MANSEAU DR
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City | WINTER HAVEN
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State | FL
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Zip | 33880-1719
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Country | US
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Telephone | 863-875-4961
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Fax | 863-229-7186
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Provider Business Mailing Address
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Address Line | 135 MANSEAU DR
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City | WINTER HAVEN
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State | FL
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Zip | 33880-1719
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Country | US
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Telephone | 863-875-4961
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Fax | 863-229-7186
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. CAYONNA M MOORE-STRODDER
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Credential |
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Telephone | 863-662-0550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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