Provider Demographics
NPI:1629680293
Name:CAREGIVER GA, LLC
Entity Type:Organization
Organization Name:CAREGIVER GA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-299-5161
Mailing Address - Street 1:4800 OVERTON PLZ STE 440
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4435
Mailing Address - Country:US
Mailing Address - Phone:800-299-5161
Mailing Address - Fax:817-447-3033
Practice Address - Street 1:3736 EXECUTIVE CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2360
Practice Address - Country:US
Practice Address - Phone:706-426-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities