Healthcare Provider Details

I. General information

NPI: 1730704396
Provider Name (Legal Business Name): COMMUNITY ACCESS & INCLUSION FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 NEAL ST
AUGUSTA GA
30906-3082
US

IV. Provider business mailing address

PO BOX 6090
AUGUSTA GA
30916-6090
US

V. Phone/Fax

Practice location:
  • Phone: 706-804-0360
  • Fax:
Mailing address:
  • Phone: 706-804-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RAFAEL EDUARDO SALAZAR II II
Title or Position: PRESIDENT
Credential: MHS, OTR/L
Phone: 706-829-6706