Provider Demographics
NPI:1689945909
Name:CSB OF EAST CENTRAL GEORGIA
Entity type:Organization
Organization Name:CSB OF EAST CENTRAL GEORGIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-432-7893
Mailing Address - Street 1:3421 MIKE PADGETT HWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-3815
Mailing Address - Country:US
Mailing Address - Phone:706-432-7893
Mailing Address - Fax:706-432-3780
Practice Address - Street 1:4054 BATH EDIE RD
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:GA
Practice Address - Zip Code:30805-3600
Practice Address - Country:US
Practice Address - Phone:706-432-7893
Practice Address - Fax:706-432-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000927693ASMedicaid
GA000927693ASMedicaid