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General NPI Number Information
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NPI Number | 1891934956
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Entity Type | Organization
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Legal Business Name | RESTORATION WORLD OUTREACH 1 INC.
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Dates
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Enumeration Date | 02/13/2009
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | 1211 SOUTH WESTERN AVE LL101
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City | CHICAGO
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State | IL
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Zip | 60608-1151
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Country | US
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Telephone | 773-710-4129
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 S WESTERN AVE LL101
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City | CHICAGO
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State | IL
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Zip | 60608-1151
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Country | US
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Telephone | 773-710-4129
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KIWANNA MARIE PHILLIPS
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Credential |
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Telephone | 773-710-4129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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