Provider Demographics
NPI:1679843825
Name:CENTRAL GEORGIA HEALTH VENTURES, INC
Entity Type:Organization
Organization Name:CENTRAL GEORGIA HEALTH VENTURES, INC
Other - Org Name:D/B/A CENTRAL GEORGIA HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP ENTERPRISE CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-633-1452
Mailing Address - Street 1:3780 EISENHOWER PKWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-0800
Mailing Address - Country:US
Mailing Address - Phone:478-633-5700
Mailing Address - Fax:478-781-3355
Practice Address - Street 1:800 1ST ST STE 100
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8395
Practice Address - Country:US
Practice Address - Phone:478-633-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GABC63186553336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000826042AMedicaid
GA000826042AMedicaid