Provider Demographics
NPI:1558705244
Name:CARESOUTH PRIVATE DUTY OF GEORGIA, LLC
Entity Type:Organization
Organization Name:CARESOUTH PRIVATE DUTY OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
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 1:231 FURYS FERRY RD
Practice Address - Street 2:STE 212
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-4728
Practice Address - Country:US
Practice Address - Phone:706-550-9966
Practice Address - Fax:706-550-9967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care