Healthcare Provider Details

I. General information

NPI: 1871853119
Provider Name (Legal Business Name): RESTORA HOSPITAL OF MESA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/21/2012
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

6120 WINDWARD PKWY SUITE 165
ALPHARETTA GA
30005-8809
US

V. Phone/Fax

Practice location:
  • Phone: 770-821-6240
  • Fax:
Mailing address:
  • Phone: 770-821-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAMES RODNEY LAUGHLIN
Title or Position: CEO & PRESIDENT
Credential:
Phone: 770-821-6225