Provider Demographics
NPI:1871853119
Name:RESTORA HOSPITAL OF MESA, LLC
Entity Type:Organization
Organization Name:RESTORA HOSPITAL OF MESA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:LAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-821-6225
Mailing Address - Street 1:6120 WINDWARD PKWY
Mailing Address - Street 2:SUITE 165
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-8809
Mailing Address - Country:US
Mailing Address - Phone:770-821-6240
Mailing Address - Fax:
Practice Address - Street 1:215 S POWER RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5235
Practice Address - Country:US
Practice Address - Phone:770-821-6240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESTORA HEALTHCARE COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility