Provider Demographics
NPI:1508841214
Name:CSRA HOLDINGS LLC
Entity Type:Organization
Organization Name:CSRA HOLDINGS LLC
Other - Org Name:TRINITY HOSPICE - AUGUSTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BUSINESS OFFICE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:2803 WRIGHTSBORO RD STE 38
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3994
Mailing Address - Country:US
Mailing Address - Phone:706-729-6000
Mailing Address - Fax:706-729-6451
Practice Address - Street 1:2803 WRIGHTSBORO RD STE 38
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-3994
Practice Address - Country:US
Practice Address - Phone:706-729-6000
Practice Address - Fax:706-729-6451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121-0273-H251G00000X
SCHPC-116251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP022Medicaid
GA000370928AMedicaid
GA000370928AMedicaid