Provider Demographics
NPI:1972973220
Name:RESTORED HOPE GUIDANCE CENTER, LLC
Entity type:Organization
Organization Name:RESTORED HOPE GUIDANCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW-CLINICAL
Authorized Official - Phone:734-793-8500
Mailing Address - Street 1:13081 RAWSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-9401
Mailing Address - Country:US
Mailing Address - Phone:734-793-8500
Mailing Address - Fax:
Practice Address - Street 1:13081 RAWSONVILLE RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-9401
Practice Address - Country:US
Practice Address - Phone:734-793-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI640101129251S00000X
MI6802061491251B00000X
MI68010991161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management