Healthcare Provider Details

I. General information

NPI: 1376860403
Provider Name (Legal Business Name): RESTORATION HEALTHCARE OF COMMERCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MEDICAL CENTER DR
COMMERCE GA
30529-1078
US

IV. Provider business mailing address

70 MEDICAL CENTER DR
COMMERCE GA
30529-1078
US

V. Phone/Fax

Practice location:
  • Phone: 706-335-1000
  • Fax: 706-335-7701
Mailing address:
  • Phone: 706-335-1000
  • Fax: 706-335-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1-078-0292
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-078-0292
License Number StateGA

VIII. Authorized Official

Name: MR. STEPHEN N CLAPP
Title or Position: PRESIDENT
Credential:
Phone: 865-607-9923