MEDICARE: HE RESTORED US, 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	3747P1801X	Personal Care Attendant	7238	LA

General Provider Information

NPI Number	:	1801090899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HE RESTORED US, LLC

Provider Business Mailing Address
First Line	:	4336 NORTH BLVD SUITE 102
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1432
Country	:	US
Telephone Number	:	225-615-8035
Fax Number	:	225-636-2501

Provider Business Practice Location Address
First Line	:	4336 NORTH BLVD STE 102
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3920
Country	:	US
Telephone Number	:	225-615-8035
Fax Number	:	225-636-2501

Authorized Official
Title or Position	:	C.E.O.
Name	:	DIENESHA RACHELL BROWN
Credential	:
Telephone Number	:	225-615-8035

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	02/03/2009

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Directions to “HE RESTORED US, LLC ” Practice Location

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