Provider Demographics
NPI:1902562093
Name:RESTORATION HORIZON SERVICES, LLC
Entity Type:Organization
Organization Name:RESTORATION HORIZON SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAWANDA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-637-1591
Mailing Address - Street 1:411 S HICKS ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-2100
Mailing Address - Country:US
Mailing Address - Phone:434-623-8227
Mailing Address - Fax:434-623-8228
Practice Address - Street 1:411 S HICKS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868-2100
Practice Address - Country:US
Practice Address - Phone:434-623-8227
Practice Address - Fax:434-623-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health