Provider Demographics
NPI:1548956824
Name:RESTORATION WELL LLC
Entity type:Organization
Organization Name:RESTORATION WELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSE-PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-399-4261
Mailing Address - Street 1:450 NE 114TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6651
Mailing Address - Country:US
Mailing Address - Phone:786-399-4261
Mailing Address - Fax:
Practice Address - Street 1:9999 NE 2ND AVE STE 218
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2345
Practice Address - Country:US
Practice Address - Phone:305-756-3940
Practice Address - Fax:305-756-3970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty