MEDICARE: CSRA PRIVATE DUTY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	157-R-0003	GA

General Provider Information

NPI Number	:	1396862496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CSRA PRIVATE DUTY, INC

Provider Business Mailing Address
First Line	:	PO BOX 254
Second Line	:
City	:	WASHINGTON
State	:	GA
Zip	:	30673-0254
Country	:	US
Telephone Number	:	706-678-3108
Fax Number	:	706-678-3111

Provider Business Practice Location Address
First Line	:	208 GORDON ST
Second Line	:
City	:	WASHINGTON
State	:	GA
Zip	:	30673-1604
Country	:	US
Telephone Number	:	706-678-3108
Fax Number	:	706-678-3111

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ROBERT R HARDY
Credential	:
Telephone Number	:	706-678-3108

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	08/22/2020

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