1346472123 NPI number — RESTORATION HOME CARE SERVICES

Table of content: KATRINA ANGELA BOZADA MD (NPI 1417118647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346472123 NPI number — RESTORATION HOME CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESTORATION HOME CARE SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RESTORATION HOME CARE SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346472123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 1ST AVE S
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
CONOVER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28613-2704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-325-3814
Provider Business Mailing Address Fax Number:
704-325-3939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 1ST AVE S
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
CONOVER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28613-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-325-3814
Provider Business Practice Location Address Fax Number:
704-325-3939
Provider Enumeration Date:
08/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SHERRILL
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/SUPERVISOR
Authorized Official Telephone Number:
704-325-3814

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HC3970 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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