Provider Demographics
NPI:1821014101
Name:CENTRAL GEORGIA HOME CARE SERVICES, INC.
Entity Type:Organization
Organization Name:CENTRAL GEORGIA HOME CARE SERVICES, INC.
Other - Org Name:THE COMPANY STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAVELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-633-1452
Mailing Address - Street 1:740 HEMLOCK STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7535
Mailing Address - Country:US
Mailing Address - Phone:478-633-6250
Mailing Address - Fax:478-633-1409
Practice Address - Street 1:740 HEMLOCK STREET
Practice Address - Street 2:SUITE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7535
Practice Address - Country:US
Practice Address - Phone:478-633-6250
Practice Address - Fax:478-633-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00826075BMedicaid
GA00826075BMedicaid