Provider Demographics
NPI:1407809643
Name:CARESOUTH HHA HOLDINGS OF LARGO, LLC
Entity Type:Organization
Organization Name:CARESOUTH HHA HOLDINGS OF LARGO, LLC
Other - Org Name:CARESOUTH HOMECARE PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-855-5533
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-0200
Mailing Address - Country:US
Mailing Address - Phone:706-855-5533
Mailing Address - Fax:706-854-7382
Practice Address - Street 1:7381 114TH AVENUE NORTH, SUITE 403-B
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5105
Practice Address - Country:US
Practice Address - Phone:727-489-0175
Practice Address - Fax:727-489-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-7709OtherMEDICARE PROVIDER
FL10-7709OtherMEDICARE PROVIDER