Provider Demographics
NPI:1861955767
Name:RESTORATION
Entity type:Organization
Organization Name:RESTORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROZELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAWTHORN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:720-301-1369
Mailing Address - Street 1:1657 S DEGAULLE WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1580 S SALIDA WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-4210
Practice Address - Country:US
Practice Address - Phone:720-301-1369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DD SQUARED INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO820822833Medicaid