# RESTORE 360 LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790350015
- **Authorized official:** OLUWASEYI EFFRAIM (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (484) 373-2710

## Contact information

- **Practice address:** 7516 CITY AVE STE 7&8, PHILADELPHIA, PA 19151-2102
- **Practice address phone:** (484) 373-2710
- **Practice address fax:** (484) 373-2710
- **Mailing address:** 600 STETSON RD, ELKINS PARK, PA 19027-2525
- **Mailing address phone:** (510) 504-4138

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/20/2021
- **Last updated:** 01/09/2024