MEDICARE: LIFE RESTORATION MISSIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1114747763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE RESTORATION MISSIONS

Provider Business Mailing Address
First Line	:	6111 SW LESSER WAY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-7040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6111 SW LESSER WAY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-7040
Country	:	US
Telephone Number	:	503-500-7744
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	JULIUS MAXIMO
Credential	:
Telephone Number	:	617-202-8004

Provider Enumeration Date	:	10/16/2024
Last Update Date	:	02/18/2026

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Directions to “LIFE RESTORATION MISSIONS ” Practice Location

Language	Start Address	Practice Location

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