Provider Demographics
NPI:1669340816
Name:VILLAGE RESTORATION CENTER
Entity type:Organization
Organization Name:VILLAGE RESTORATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES CISNEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-788-8509
Mailing Address - Street 1:1209 MOUNTAIN ROAD PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7845
Mailing Address - Country:US
Mailing Address - Phone:480-788-8509
Mailing Address - Fax:
Practice Address - Street 1:1209 MOUNTAIN ROAD PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7845
Practice Address - Country:US
Practice Address - Phone:480-788-8509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty