Restore 360 LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

RESTORE 360 LLC

Practice address

7516 City Ave Ste 7&8
Philadelphia, PA 19151-2102

Phone

(484) 373-2710

Fax

(484) 373-2710

NPI assigned

May 20, 2021

Organization subpart

No

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

Authorized official

Name

Oluwaseyi EffraimNPI 1902586043

Title

Executive Director

Phone

(484) 373-2710

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Oluwaseyi Oluwaseun Effraim, MPH MSN CRNP PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Philadelphia, PA
  • NPI 1902586043
  Medicare reassignment Care Compare group Authorized official
• Oluwadamilola Fowowe, CRNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Horsham, PA
  • NPI 1760838783
  Medicare reassignment Care Compare group NPD
• Maleakah M Briggs, LPC

  • Professional Counselor
  • Philadelphia, PA
  • NPI 1912655341

  Single Specialty

  Medicare reassignment NPD
• Shasha D'My Jones, MS, LPC, NCC, CBIS

  • Professional Counselor
  • Lansdowne, PA
  • NPI 1881229169

  Single Specialty

  NPD

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

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1790350015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 STETSON RD",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190272525",
            "telephone_number": "510-504-4138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7516 CITY AVE STE 7&8",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191512102",
            "telephone_number": "484-373-2710",
            "fax_number": "484-373-2710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE 360 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-20",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "EFFRAIM",
        "authorized_official_first_name": "OLUWASEYI",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "484-373-2710"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa J Ressler, MA
• Restorative Medical Equipment and Supplies
• Restorative Path Therapy LLC
• Restorative Speech and Swallow LLC
• Restore & Reset Counseling Services, LLC
• Restore Physical Therapy and Pelvic Health, LLC (Restore Physical Therapy and Pelvic Health)
• Restorer Home Health Services LLC
• Hanna Retallack
• Carolina I Retamero, M.D.
• Retap Life PLLC

• Psychiatric/Mental Health Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.