MEDICARE: REST ASSURED 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	320800000X	Mental Illness Community Based Residential Treatment Facility	126614001	VA

General Provider Information

NPI Number	:	1578896171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REST ASSURED LLC

Provider Business Mailing Address
First Line	:	4003 COLLINGBOURNE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-1521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3830 MONZA DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23234-4214
Country	:	US
Telephone Number	:	804-279-9347
Fax Number	:

Authorized Official
Title or Position	:	CAO
Name	:	MRS. CHERODNICKER T BROWN
Credential	:	MA
Telephone Number	:	804-267-3565

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	09/14/2009

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