| 4 2 Restore Llc | |
|
3527 N Rolling Rd Ste 4 Windsor Mill MD 21244-2256 | |
| (410) 701-9190 | |
| (410) 701-7483 |
| Full Name | 4 2 Restore Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3527 N Rolling Rd Ste 4, Windsor Mill, Maryland |
| Authorized Official Name and Position | Deadra Monique Martin (CEO) |
| Authorized Official Contact | 4107019190 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 4 2 Restore Llc 3527 N Rolling Rd Ste 4 Windsor Mill MD 21244-2256 Ph: (410) 701-9190 | 4 2 Restore Llc 3527 N Rolling Rd Ste 4 Windsor Mill MD 21244-2256 Ph: (410) 701-9190 |
| NPI Number | 1427661883 |
|---|---|
| Provider Enumeration Date | 08/26/2020 |
| Last Update Date | 10/13/2020 |
| Certification Date | 10/13/2020 |
| Medicare PECOS PAC ID | 2062889629 |
|---|---|
| Medicare Enrollment ID | O20221110002341 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427661883 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Matthew H Mauro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154915387 PECOS PAC ID: 5991193450 Enrollment ID: I20211102002826 |
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