Healthcare Provider Details

I. General information

NPI: 1245228170
Provider Name (Legal Business Name): HEARTHSTONE HOSPITAL MESA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 01/22/2009
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

215 S POWER RD
MESA AZ
85206-5235
US

V. Phone/Fax

Practice location:
  • Phone: 480-985-6992
  • Fax: 480-981-8390
Mailing address:
  • Phone: 480-985-6992
  • Fax: 480-981-8390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI 386
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSH 4388
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License NumberSH 4388
License Number StateAZ

VIII. Authorized Official

Name: MRS. BARBARA ANN MAHER
Title or Position: DIRECTOR OF FINANCIAL SERVICES
Credential:
Phone: 480-329-2877