MEDICARE: R.W.A. RESTORATION 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	171WH0202X	Home Modifications Contractor	2705135558	VA

General Provider Information

NPI Number	:	1548530082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R.W.A. RESTORATION LLC

Provider Business Mailing Address
First Line	:	845 CREPE MYRTLE LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-5813
Country	:	US
Telephone Number	:	757-630-5870
Fax Number	:	757-277-0100

Provider Business Practice Location Address
First Line	:	845 CREPE MYRTLE LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-5813
Country	:	US
Telephone Number	:	757-630-5870
Fax Number	:	757-277-0100

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ANDREA JEAN CASTLE
Credential	:
Telephone Number	:	757-630-5870

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	12/30/2011

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