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Organization

RESTORER OF YOUTH AND FAMILIES LLC

Active
Parent organization
RESTORER OF YOUTH AND FAMILIES LLC
Organization subpart
Yes

Provider details

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

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary

Other

Enumeration date
06/02/2020
Last updated
06/02/2020
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