Provider Demographics
NPI:1669482261
Name:CSRA HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:CSRA HOME HEALTH AGENCY, INC.
Other - Org Name:CENTRAL SAVANNAH RIVER AREA HOME HEALTH AGENCY, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:C.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-344-6371
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:127 GORDON ST.
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673-0189
Mailing Address - Country:US
Mailing Address - Phone:800-344-6371
Mailing Address - Fax:706-678-3049
Practice Address - Street 1:127 GORDON ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673-1601
Practice Address - Country:US
Practice Address - Phone:800-344-6371
Practice Address - Fax:706-678-3049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA157-040251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA495992004AMedicaid
GA00195401DMedicaid
GA00195401AMedicaid
GA00195401DMedicaid