Provider Demographics
NPI:1154698520
Name:RESTORATION RESIDENTIAL SERVICES, LLC
Entity type:Organization
Organization Name:RESTORATION RESIDENTIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SEREADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-727-6299
Mailing Address - Street 1:150 SPY GLASS WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8548
Mailing Address - Country:US
Mailing Address - Phone:615-727-6299
Mailing Address - Fax:615-229-0272
Practice Address - Street 1:1160 GALLATIN PIKE S STE 202
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4627
Practice Address - Country:US
Practice Address - Phone:615-727-6299
Practice Address - Fax:615-229-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL00000008979251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services