Provider Demographics
NPI:1720804289
Name:ROAD TO EMPOWERMENT RESTORATIVE SERVICES
Entity type:Organization
Organization Name:ROAD TO EMPOWERMENT RESTORATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:707-200-3686
Mailing Address - Street 1:8125 WHITED RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4036
Mailing Address - Country:US
Mailing Address - Phone:707-200-3686
Mailing Address - Fax:
Practice Address - Street 1:8125 WHITED RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4036
Practice Address - Country:US
Practice Address - Phone:707-200-3686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management