National Provider Identifier Database

RESTORATION HEALTH CARE OF COMMERCE LLC
Rural


Contact Information

RESTORATION HEALTH CARE OF COMMERCE, LLC
70 MEDICAL CENTER DRIVE
COMMERCE, GA30529
Phone: 706-335-1000
Fax: 706-335-7701
Website:
Specialty Taxonomy Code
* Rural 282NR1301X
Medicare Defined Swing Bed Unit 275N00000X
Psychiatric Unit 273R00000X

* Indicates primary specialty

NPI Profile & details for RESTORATION HEALTH CARE OF COMMERCE, LLC

NPI Number 1912079039
Legal business name
LBN
RESTORATION HEALTH CARE OF COMMERCE, LLC
Authorized official JERRY WISE - (DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 11/14/2006
Last updated 08/12/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • GA Medicaid: 00000151A
  • GA Medicaid: 00000151D
  • GA Medicaid: 00000151S
  • GA Medicaid: 00059331A
  • GA Medicaid: 00304059G
  • GA Medicaid: 00559248C
  • GA Medicaid: 00808244A
  • GA Other: 000042 BLUE CROSS
  • GA Other: 852155 BLUE CROSS CLINIC
  • GA Other: 191184 BLUE CROSS CRNA

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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