Provider Demographics
NPI:1396303616
Name:RESTORATION 1:99
Entity type:Organization
Organization Name:RESTORATION 1:99
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIR
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:202-213-6025
Mailing Address - Street 1:PO BOX 15674
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-0674
Mailing Address - Country:US
Mailing Address - Phone:202-202-2136
Mailing Address - Fax:
Practice Address - Street 1:600 W ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1285
Practice Address - Country:US
Practice Address - Phone:202-202-2136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health