1508496258 NPI number — RESTORED TO NEW LIFE SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508496258 NPI number — RESTORED TO NEW LIFE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESTORED TO NEW LIFE SERVICES, LLC
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:
Provider Other Organization Name Type Code:
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:
1508496258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1915 E 8TH ST STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57103-1865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-271-7712
Provider Business Mailing Address Fax Number:
605-274-1557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 E 11TH ST STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57104-6482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-271-7712
Provider Business Practice Location Address Fax Number:
605-274-1557
Provider Enumeration Date:
01/22/2020

Additional Information

Authorized Official

Authorized Official Last Name:
RAY
Authorized Official First Name:
JOHNNY
Authorized Official Middle Name:
RANDLE
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
605-271-7712

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com