MEDICARE: RESTORER HOME HEALTH SERVICES LLC

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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1508382557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORER HOME HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	10065 SANDMEYER LN STE 301
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-3528
Country	:	US
Telephone Number	:	267-343-8505
Fax Number	:	267-343-7976

Provider Business Practice Location Address
First Line	:	10065 SANDMEYER LN STE 301
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-3528
Country	:	US
Telephone Number	:	267-343-8505
Fax Number	:	267-343-7976

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	WALE DAVIS
Credential	:
Telephone Number	:	267-343-8505

Provider Enumeration Date	:	08/21/2017
Last Update Date	:	11/02/2022

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