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General NPI Number Information
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NPI Number | 1669482261
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Entity Type | Organization
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Legal Business Name | CSRA HOME HEALTH AGENCY, INC.
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 127 GORDON ST
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City | WASHINGTON
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State | GA
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Zip | 30673-1601
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Country | US
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Telephone | 800-344-6371
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Fax | 706-678-3049
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Provider Business Mailing Address
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Address Line | PO BOX 189 127 GORDON ST.
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City | WASHINGTON
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State | GA
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Zip | 30673-0189
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Country | US
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Telephone | 800-344-6371
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Fax | 706-678-3049
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Authorized Official
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Title or Position | CEO
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Name | MR. C. SCOTT BRADFORD
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Credential |
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Telephone | 800-344-6371
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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 | 157-040
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License Number State | GA
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