MEDICARE: CARESOUTH HHA HOLDINGS OF LARGO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10-7709	OTHER	FL	MEDICARE PROVIDER

General Provider Information

NPI Number	:	1407809643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARESOUTH HHA HOLDINGS OF LARGO, LLC

Provider Business Mailing Address
First Line	:	PO BOX 200
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30903-0200
Country	:	US
Telephone Number	:	706-855-5533
Fax Number	:	706-854-7382

Provider Business Practice Location Address
First Line	:	7381 114TH AVENUE NORTH, SUITE 403-B
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-5105
Country	:	US
Telephone Number	:	727-489-0175
Fax Number	:	727-489-0178

Authorized Official
Title or Position	:	PRES/CEO
Name	:	MR. RICK W GRIFFIN
Credential	:
Telephone Number	:	706-855-5533

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/23/2013

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