Provider Demographics
NPI:1811912249
Name:CENTRAL GEORGIA HOMECARE SERVICES, INC
Entity type:Organization
Organization Name:CENTRAL GEORGIA HOMECARE SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP-CFO
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-633-1452
Mailing Address - Street 1:800 1ST STREET
Mailing Address - Street 2:STE 100
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8395
Mailing Address - Country:US
Mailing Address - Phone:478-633-5700
Mailing Address - Fax:478-784-3574
Practice Address - Street 1:800 1ST STREET
Practice Address - Street 2:STE 100
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:478-784-3574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE 008012332BP3500X, 3336H0001X
GA20012623968332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000826042BMedicaid
GA000826075BMedicaid
GA000826075AMedicaid
GA1263140001Medicare NSC