MEDICARE: CSB OF EAST CENTAL GA

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1407395023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CSB OF EAST CENTAL GA

Provider Business Mailing Address
First Line	:	3421 MIKE PADGETT HWY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-3815
Country	:	US
Telephone Number	:	706-432-4858
Fax Number	:	706-432-3861

Provider Business Practice Location Address
First Line	:	3535 BILTMORE PL
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-4503
Country	:	US
Telephone Number	:	706-386-5235
Fax Number	:	706-432-3861

Authorized Official
Title or Position	:	RESIDENTIAL MANAGER
Name	:	HEATHER DUBOSE
Credential	:
Telephone Number	:	706-432-3798

Provider Enumeration Date	:	02/15/2017
Last Update Date	:	02/15/2017

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Directions to “CSB OF EAST CENTAL GA ” Practice Location

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