NPIMap

Organization Active NPI

4 2 Restore LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Windsor Mill, MD
National Provider Identifier
1265044788
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
4 2 RESTORE LLC
Practice address
3527 N Rolling Rd Ste 4
Windsor Mill, MD 21244-2256
Phone
(410) 701-9190
Fax
(410) 701-7483
NPI assigned
Aug 17, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Deadra Monique Martin
Title
Ceo
Phone
(410) 701-9190

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

3527 N Rolling Rd Ste 4
Windsor Mill, MD 21244-2256

Mailing address

3527 N Rolling Rd Ste 4
Windsor Mill, MD 21244-2256
Phone (410) 701-9190

National Provider Directory

National Provider Directory
Tax ID family
4 2 Restore LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1265044788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3527 N ROLLING RD STE 4",
            "city": "WINDSOR MILL",
            "state": "MD",
            "postal_code": "212442256",
            "telephone_number": "410-701-9190",
            "fax_number": "410-701-7483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3527 N ROLLING RD STE 4",
            "city": "WINDSOR MILL",
            "state": "MD",
            "postal_code": "212442256",
            "telephone_number": "410-701-9190",
            "fax_number": "410-701-7483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "4 2 RESTORE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-17",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "DEADRA",
        "authorized_official_middle_name": "MONIQUE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-701-9190",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Windsor Mill, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.