Provider Demographics
NPI:1932842994
Name:FAMILY RESTORATION CENTER, LLC
Entity type:Organization
Organization Name:FAMILY RESTORATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:256-612-8355
Mailing Address - Street 1:8089 HIGHWAY 72 W STE D
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9531
Mailing Address - Country:US
Mailing Address - Phone:256-612-8355
Mailing Address - Fax:
Practice Address - Street 1:8089 HIGHWAY 72 W STE D
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9531
Practice Address - Country:US
Practice Address - Phone:256-612-8355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)