Provider Demographics
NPI:1528244860
Name:CARESOUTH HHA HOLDINGS OF THE PLATINUM COAST, LLC
Entity type:Organization
Organization Name:CARESOUTH HHA HOLDINGS OF THE PLATINUM COAST, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:3135 SOUTHGATE CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5515
Practice Address - Country:US
Practice Address - Phone:941-870-0194
Practice Address - Fax:941-870-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL107202251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651168600Medicaid
FL470914815OtherEIN#
FL470914815OtherEIN#