Healthcare Provider Details

I. General information

NPI: 1346915741
Provider Name (Legal Business Name): RESTORE HEALTH AT VERVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 E BASELINE RD STE 140
MESA AZ
85206-4680
US

IV. Provider business mailing address

4824 E BASELINE RD STE 140
MESA AZ
85206-4680
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-4040
  • Fax: 480-830-1042
Mailing address:
  • Phone: 480-969-4040
  • Fax: 480-830-1042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. BETHANY S WRIGHT
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 310-770-6368