# RESTORER OF YOUTH AND FAMILIES LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** RESTORER OF YOUTH AND FAMILIES LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1063036424
- **Legal business name:** RESTORER OF YOUTH AND FAMILIES LLC
- **Authorized official:** DR. MICHAEL RUSSELL BAINES (ADMIN)
- **Authorized official phone:** (918) 852-4695

## Contact information

- **Practice address:** 1831 E 71ST ST, TULSA, OK 74136-3922
- **Practice address phone:** (918) 852-4695
- **Practice address fax:** (918) 205-9036
- **Mailing address:** 5553 S PEORIA AVE STE 103, TULSA, OK 74105-6840
- **Mailing address phone:** (918) 852-4695
- **Mailing address fax:** (918) 205-9036

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/02/2020
- **Last updated:** 06/02/2020