Provider Demographics
NPI:1912732512
Name:RESTORATIVE MANNER HOME LLC
Entity type:Organization
Organization Name:RESTORATIVE MANNER HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AIESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:615-319-4182
Mailing Address - Street 1:7439 HIGHWAY 70 S STE 145
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-1734
Mailing Address - Country:US
Mailing Address - Phone:615-319-4182
Mailing Address - Fax:
Practice Address - Street 1:7439 HIGHWAY 70 S STE 145
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-1734
Practice Address - Country:US
Practice Address - Phone:615-319-4182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care