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General NPI Number Information
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NPI Number | 1609696905
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Entity Type | Organization
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Legal Business Name | RESTORATION HOUSE MINISTRIES
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Dates
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Enumeration Date | 10/12/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 154 LEE GREENWOOD WAY
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City | KODAK
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State | TN
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Zip | 37764-2169
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Country | US
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Telephone | 865-352-1274
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 367
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City | NEWPORT
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State | TN
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Zip | 37822-0367
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Country | US
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Telephone |
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Fax | 423-205-8024
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Authorized Official
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Title or Position | CEO
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Name | MATTHEW TERRY JOHNSON
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Credential |
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Telephone | 865-805-0567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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