Organization
THE RESTORATION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GWEN PARKS (EXECUTIVE DIRECTOR)
(973) 622-4934
Entity
Organization
Contact information
Practice address
300 S 12TH ST, NEWARK, NJ 07103-1960
(973) 622-4934
(973) 622-5820
Mailing address
300 S 12TH ST, NEWARK, NJ 07103-1960
(973) 622-4934
(973) 622-5820
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
2000116
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0273082
—
NJ
Enumeration date
07/06/2012
Last updated
07/06/2012
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