Provider Demographics
NPI:1124514567
Name:RESTORED BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:RESTORED BEHAVIORAL HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BANKOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIATONU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-760-8701
Mailing Address - Street 1:6495 NEW HAMPSHIRE AVE STE A303
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3245
Mailing Address - Country:US
Mailing Address - Phone:240-667-2357
Mailing Address - Fax:240-667-2743
Practice Address - Street 1:6495 NEW HAMPSHIRE AVE STE A303
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3245
Practice Address - Country:US
Practice Address - Phone:240-667-2357
Practice Address - Fax:240-667-2743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X, 251S00000X
MD261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health