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General NPI Number Information
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NPI Number | 1821710864
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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 | 09/15/2022
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 2450 WINFIELD DUNN PKWY
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City | KODAK
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State | TN
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Zip | 37764-2100
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Country | US
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Telephone | 865-805-0567
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 WINFIELD DUNN PKWY
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City | KODAK
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State | TN
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Zip | 37764-2100
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MATTHEW JOHNSON
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Credential | M.A., M.DIV
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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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 | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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