Organization
RESTORE 360 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLUWASEYI EFFRAIM (EXECUTIVE DIRECTOR)
(484) 373-2710
Entity
Organization
Contact information
Practice address
7516 CITY AVE STE 7&8, PHILADELPHIA, PA 19151-2102
(484) 373-2710
(484) 373-2710
Mailing address
600 STETSON RD, ELKINS PARK, PA 19027-2525
(510) 504-4138
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/20/2021
Last updated
01/09/2024
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