Provider Demographics
NPI:1578519062
Name:RESTORACARE, INC.
Entity Type:Organization
Organization Name:RESTORACARE, INC.
Other - Org Name:AT HOME MED REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:VAN ARSDELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-619-8582
Mailing Address - Street 1:5901 E MCKELLIPS RD # 109-321
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-2700
Mailing Address - Country:US
Mailing Address - Phone:602-619-8582
Mailing Address - Fax:480-654-0054
Practice Address - Street 1:6303 E MALLORY ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2114
Practice Address - Country:US
Practice Address - Phone:602-619-8582
Practice Address - Fax:480-654-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0460670OtherBCBS PT AND OT BILLING #
AZ726052Medicaid
AZAZ0460670OtherBCBS PT AND OT BILLING #