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General NPI Number Information
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NPI Number | 1396862496
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Entity Type | Organization
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Legal Business Name | CSRA PRIVATE DUTY, INC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 208 GORDON ST
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City | WASHINGTON
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State | GA
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Zip | 30673-1604
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Country | US
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Telephone | 706-678-3108
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Fax | 706-678-3111
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Provider Business Mailing Address
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Address Line | PO BOX 254
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City | WASHINGTON
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State | GA
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Zip | 30673-0254
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Country | US
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Telephone | 706-678-3108
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Fax | 706-678-3111
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROBERT R HARDY
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Credential |
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Telephone | 706-678-3108
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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 | 157-R-0003
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License Number State | GA
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