Provider Demographics
NPI:1992287064
Name:RESTORATION FAMILY SERVICES
Entity type:Organization
Organization Name:RESTORATION FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:316-339-8892
Mailing Address - Street 1:3450 N ROCK RD STE 405
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1354
Mailing Address - Country:US
Mailing Address - Phone:316-779-8185
Mailing Address - Fax:
Practice Address - Street 1:3450 N ROCK RD STE 405
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1354
Practice Address - Country:US
Practice Address - Phone:316-779-8185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
KS0077096-001253J00000X
KS385HR2055X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253J00000XAgenciesFoster Care Agency
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, ChildGroup - Single Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child