Provider Demographics
NPI:1235117581
Name:CARESOUTH HHA HOLDINGS OF GAINESVILLE, LLC
Entity Type:Organization
Organization Name:CARESOUTH HHA HOLDINGS OF GAINESVILLE, LLC
Other - Org Name:ENHABIT HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRISSY
Authorized Official - Middle Name:BUCHANAN
Authorized Official - Last Name:CARLISLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-239-6500
Mailing Address - Street 1:6688 N CENTRAL EXPRESSWAY
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-3950
Mailing Address - Country:US
Mailing Address - Phone:214-239-6500
Mailing Address - Fax:214-239-6581
Practice Address - Street 1:601 BROAD ST SE
Practice Address - Street 2:SUITE F
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3729
Practice Address - Country:US
Practice Address - Phone:770-536-0497
Practice Address - Fax:770-536-0157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENHABIT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-06
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069-290-H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00310362AMedicaid
GA00310362FMedicaid
GA00310362CMedicaid
GA11D0945587OtherCLIA
GA00310362FMedicaid