Provider Demographics
NPI:1609193572
Name:CARESOUTH HHA HOLDINGS OF VIRGINIA BEACH, LLC
Entity Type:Organization
Organization Name:CARESOUTH HHA HOLDINGS OF VIRGINIA BEACH, 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 1:5301 PROVIDENCE RD
Practice Address - Street 2:SUITE 30
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4128
Practice Address - Country:US
Practice Address - Phone:757-873-3315
Practice Address - Fax:757-873-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA497523Medicare Oscar/Certification