Provider Demographics
NPI:1063118370
Name:RESTORE LIFE BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:RESTORE LIFE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-627-6585
Mailing Address - Street 1:2 E ROLLING XRDS STE 157
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6213
Mailing Address - Country:US
Mailing Address - Phone:410-627-6585
Mailing Address - Fax:
Practice Address - Street 1:2 E ROLLING XRDS STE 157
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6213
Practice Address - Country:US
Practice Address - Phone:410-627-6585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility