Provider Demographics
NPI:1568074813
Name:CSSGACA, LLC
Entity Type:Organization
Organization Name:CSSGACA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLAES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-226-6393
Mailing Address - Street 1:201 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4657
Mailing Address - Country:US
Mailing Address - Phone:210-226-6393
Mailing Address - Fax:
Practice Address - Street 1:311 E MAIN ST STE 305
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-4867
Practice Address - Country:US
Practice Address - Phone:309-228-4222
Practice Address - Fax:866-557-9176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care