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General NPI Number Information
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NPI Number | 1568074813
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Entity Type | Organization
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Legal Business Name | CSSGACA, LLC
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 311 E MAIN ST STE 305
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City | GALESBURG
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State | IL
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Zip | 61401-4867
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Country | US
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Telephone | 309-228-4222
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Fax | 866-557-9176
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Provider Business Mailing Address
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Address Line | 201 E PARK AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-4657
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Country | US
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Telephone | 210-226-6393
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. IAN KLAES
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Credential |
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Telephone | 210-226-6393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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