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General NPI Number Information
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NPI Number | 1992525679
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Entity Type | Organization
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Legal Business Name | RESTORED LIVING LLC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 2484 OLD HARFORD RD 2484 OLD HARFORD RD
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City | PARKVILLE
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State | MD
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Zip | 21234
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Country | US
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Telephone | 410-882-1715
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Fax |
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Provider Business Mailing Address
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Address Line | 3044 CALIFORNIA AVE
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City | PARKVILLE
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State | MD
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Zip | 21234-4141
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Country | US
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Telephone | 917-378-2269
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | OKPENZE FELICIA BALLARD
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Credential | PMHNP
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Telephone | 917-378-2269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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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 | 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 #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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