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General NPI Number Information
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NPI Number | 1982581849
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Entity Type | Organization
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Legal Business Name | RESTORE GRACE SUPPORT
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 3886 GREEN POINT DR
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City | GREENSBORO
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State | NC
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Zip | 27407-4506
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Country | US
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Telephone | 336-897-5972
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Fax |
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Provider Business Mailing Address
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Address Line | 3886 GREEN POINT DR
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City | GREENSBORO
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State | NC
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Zip | 27407-4506
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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 | PROGRAM DIRECTOR
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Name | LYNLY GATES
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Credential |
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Telephone | 904-547-0911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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