MEDICARE: CARESOUTH HHA HOLDINGS OF THE PLATINUM COAST, LLC

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	107202	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528244860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARESOUTH HHA HOLDINGS OF THE PLATINUM COAST, LLC

Provider Business Mailing Address
First Line	:	PO BOX 200
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30903-0200
Country	:	US
Telephone Number	:	706-855-5533
Fax Number	:	706-854-7382

Provider Business Practice Location Address
First Line	:	3135 SOUTHGATE CIR
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-5515
Country	:	US
Telephone Number	:	941-870-0194
Fax Number	:	941-870-0198

Authorized Official
Title or Position	:	PRES/CEO
Name	:	MR. RICK W GRIFFIN
Credential	:
Telephone Number	:	706-855-5533

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	09/09/2013

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