Organization
4 2 RESTORE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEADRA MONQIUE MARTIN (CEO)
(410) 701-9190
Entity
Organization
Contact information
Practice address
2506 ROSLYN AVE, BALTIMORE, MD 21216-2214
(410) 701-9190
(410) 901-7483
Mailing address
3527 N ROLLING RD STE 4, WINDSOR MILL, MD 21244-2256
(410) 701-9190
(410) 901-7483
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
08/17/2020
Last updated
06/11/2021
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