MEDICARE: RESTOR8TION

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1477110831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTOR8TION

Provider Business Mailing Address
First Line	:	815 FROST RD APT 1001
Second Line	:
City	:	STREETSBORO
State	:	OH
Zip	:	44241-4735
Country	:	US
Telephone Number	:	216-849-3390
Fax Number	:

Provider Business Practice Location Address
First Line	:	3631 PERKINS AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-4705
Country	:	US
Telephone Number	:	216-849-3390
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	MS. ARDELLE MICHELLE MOORE
Credential	:	LISW-S, LICDC-CS
Telephone Number	:	216-849-3390

Provider Enumeration Date	:	05/21/2019
Last Update Date	:	05/21/2019

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Directions to “RESTOR8TION ” Practice Location

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