Organization
RESTORATION HEALTH CARE OF COMMERCE, LLC
Active
Other names
Northridge Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY WISE (DIRECTOR)
(706) 335-1101
Entity
Organization
Contact information
Practice address
70 MEDICAL CENTER DRIVE, COMMERCE, GA 30529
(706) 335-1000
(706) 335-7701
Mailing address
70 MEDICAL CENTER DRIVE, COMMERCE, GA 30529
(706) 335-1120
(706) 335-6033
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
—
—
275N00000X
Medicare Defined Swing Bed Hospital Unit
—
—
282NR1301X
Rural Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000151A
—
GA
05
—
00000151D
—
GA
05
—
00000151S
—
GA
01
—
000042
BLUE CROSS
GA
05
—
00059331A
—
GA
05
—
00304059G
—
GA
05
—
00559248C
—
GA
05
—
00808244A
—
GA
01
—
191184
BLUE CROSS CRNA
GA
01
—
852155
BLUE CROSS CLINIC
GA
Enumeration date
11/14/2006
Last updated
08/12/2020
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