Provider Demographics
NPI:1386349074
Name:RESTORATION OF EAGLES INTERNATIONAL
Entity type:Organization
Organization Name:RESTORATION OF EAGLES INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:ZENO
Authorized Official - Middle Name:
Authorized Official - Last Name:DARDEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:219-777-0853
Mailing Address - Street 1:PO BOX 10992
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411-0992
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2440 WILSON ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3249
Practice Address - Country:US
Practice Address - Phone:219-777-0853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty