Healthcare Provider Details

I. General information

NPI: 1396872719
Provider Name (Legal Business Name): HEARTHSTONE HOSPITAL - MESA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S POWER RD
MESA AZ
85206-5235
US

IV. Provider business mailing address

4440 N CIVIC CENTER PLZ
SCOTTSDALE AZ
85251-3513
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-7711
  • Fax: 480-945-8266
Mailing address:
  • Phone: 480-945-7711
  • Fax: 480-945-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License NumberSH 4388
License Number StateAZ

VIII. Authorized Official

Name: MR. GLENN DE SOUZA
Title or Position: CEO
Credential:
Phone: 480-945-7711