Provider Demographics
NPI:1104077361
Name:CSS CORP
Entity type:Organization
Organization Name:CSS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGULUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-210-0631
Mailing Address - Street 1:8896 TARA BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-4977
Mailing Address - Country:US
Mailing Address - Phone:770-210-0631
Mailing Address - Fax:770-210-0653
Practice Address - Street 1:8896 TARA BLVD STE 500
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-4977
Practice Address - Country:US
Practice Address - Phone:770-210-0631
Practice Address - Fax:770-210-0653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031-R-0011251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health