Provider Demographics
NPI:1265442784
Name:CSRA HOME HEALTH AGENCY-COLUMBIA, INC.
Entity Type:Organization
Organization Name:CSRA HOME HEALTH AGENCY-COLUMBIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:C.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-344-6371
Mailing Address - Street 1:415 W HILL ST STE 1
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-2105
Mailing Address - Country:US
Mailing Address - Phone:800-914-9688
Mailing Address - Fax:706-595-5547
Practice Address - Street 1:415 W HILL ST
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-2105
Practice Address - Country:US
Practice Address - Phone:800-914-9688
Practice Address - Fax:706-595-5547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA097-189251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000750901BMedicaid
GA000750901CMedicaid
GA00222532AMedicaid
GA11-7108Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER