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General NPI Number Information
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NPI Number | 1104077361
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Entity Type | Organization
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Legal Business Name | CSS CORP
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 8896 TARA BLVD STE 500
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City | JONESBORO
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State | GA
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Zip | 30236-4977
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Country | US
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Telephone | 770-210-0631
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Fax | 770-210-0653
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Provider Business Mailing Address
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Address Line | 8896 TARA BLVD STE 500
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City | JONESBORO
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State | GA
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Zip | 30236-4977
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Country | US
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Telephone | 770-210-0631
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Fax | 770-210-0653
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOHN AGULUE
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Credential |
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Telephone | 770-210-0631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 031-R-0011
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License Number State | GA
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