Provider Demographics
NPI:1255323788
Name:COMMUNITY ANCILLARY SERVICES, INC.
Entity Type:Organization
Organization Name:COMMUNITY ANCILLARY SERVICES, INC.
Other - Org Name:ELDERCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RUSTY
Authorized Official - Last Name:LEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-783-1515
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-0997
Mailing Address - Country:US
Mailing Address - Phone:478-783-1515
Mailing Address - Fax:478-783-1404
Practice Address - Street 1:342 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-2106
Practice Address - Country:US
Practice Address - Phone:478-783-1515
Practice Address - Fax:478-783-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
GAPHRE006980333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00377858BMedicaid
GA1135359OtherNCPDP
GA00377858AMedicaid
GA5014690001Medicare NSC