Provider Demographics
NPI:1528527249
Name:RESTORE OUTREACH TRANSPORTATION, LLC
Entity type:Organization
Organization Name:RESTORE OUTREACH TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAWANA
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-223-6968
Mailing Address - Street 1:4315 BLUEBONNET BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-9661
Mailing Address - Country:US
Mailing Address - Phone:225-223-6968
Mailing Address - Fax:225-442-1396
Practice Address - Street 1:4315 BLUEBONNET BLVD STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-9661
Practice Address - Country:US
Practice Address - Phone:225-223-6968
Practice Address - Fax:225-442-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)