Healthcare Provider Details

I. General information

NPI: 1508855115
Provider Name (Legal Business Name): AUGUSTA RESOURCE CENTER ON AGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 OWENS RD
EVANS GA
30809-3066
US

IV. Provider business mailing address

4275 OWENS RD
EVANS GA
30809-3066
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-3526
  • Fax: 706-868-3525
Mailing address:
  • Phone: 706-868-3526
  • Fax: 706-868-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD KISNER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 706-868-3527