Provider Demographics
NPI:1780637082
Name:CARESOUTH HHA HOLDINGS OF THE SUNSHINE COAST LLC
Entity Type:Organization
Organization Name:CARESOUTH HHA HOLDINGS OF THE SUNSHINE COAST 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 1:5420 NW 33RD AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-6348
Practice Address - Country:US
Practice Address - Phone:954-486-4930
Practice Address - Fax:954-486-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651094432OtherTAX ID
FL107242Medicare ID - Type Unspecified