CSB OF EAST CENTRAL GA (NPI# 1053642686) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053642686 |
| Entity Type | Organization |
| Organization Name | CSB OF EAST CENTRAL GA |
| Other Organization Name | GRACE PCH |
| Practice Address |
2115 Ashley Dr Augusta GA 30906-5085 |
| Mailing Address |
3421 Mike Padgett Hwy Augusta GA 30906-3815 |
| Practice Telephone | 7064324858 |
| Practice Fax Number | 7064323780 |
| Enumeration Date | 2010-01-21 |
| Last Update Date | 2010-01-21 |
| Authorized Official Name | WANDA JESSIE (BILLING MANAGER) |
| Authorized Official Telephone | 7064324858 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000927693AA | 05 |
| Other Name | Type Code |
|---|---|
| GRACE PCH | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467013821 | Csb of East Central Ga | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5101 Parnell Way, Martinez, GA 30907-8896 | 2019-06-26 |
| 1811436512 | Csb of East Central Ga | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4008 Ramswood Dr, Hephzibah, GA 30815-5849 | 2017-02-15 |
| 1508305285 | Csb of East Central Ga | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3126 Richmond Hill Rd, Augusta, GA 30906-4754 | 2017-02-15 |
| 1447798707 | Csb of East Central Ga | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 355 Bobwhite Trl, Grovetown, GA 30813-5886 | 2017-02-07 |
| 1346565926 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3015 Manchester Dr, Hephzibah, GA 30815-7166 | 2010-04-07 |
| 1700101391 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2006 Country Place Dr, Augusta, GA 30906-8732 | 2010-04-07 |
| 1588995112 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 386 Tower Rd, Augusta, GA 30907-8750 | 2010-01-21 |
| 1881925410 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3461 Camak Dr, Augusta, GA 30909-9433 | 2010-01-21 |
| 1679804215 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2208 Walden Dr, Augusta, GA 30904-6508 | 2010-01-21 |
| 1790016327 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2110 Stevens Rd, Augusta, GA 30906-2058 | 2010-01-21 |
| Street Address |
2115 ASHLEY DR |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30906-5085 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255969432 | Barton Chapel Dental Group, LLC | Dentist | 2755 Barton Chapel Road, Augusta, GA 30906 | 2020-04-01 |
| 1255897419 | Pediatric Mobility Innovations | Durable Medical Equipment & Medical Supplies | 3114 Augusta Tech Drive Suite 404, Augusta, GA 30906 | 2019-02-13 |
| 1023539731 | Kristy Lee Gibbs | Registered Nurse | 3421 Mike Padgett Hwy Bldg C, Augusta, GA 30906 | 2017-07-03 |
| 1194186031 | Clifton Nane Williams | Counselor | 3230 Hampton Circle, Augusta, GA 30906 | 2016-03-18 |
| 1376929661 | Catherine A. Ganzy | Social Worker | 3405 Mike Padgett Highway; Building 201, East Central Regional Hosptial, Augusta, GA 30906 | 2015-08-10 |
| 1962810358 | Fatemeh Azadeh Paziraei | Dentist | 1631 Gordon Highway, Augusta Smiles Youth Dentistry, Augusta, GA 30906 | 2014-07-29 |
| 1568809770 | Brandon Jennings | Occupational Therapy Assistant | 2388 Old Mcduffie Rd, Augusta, GA 30906 | 2013-05-29 |
| 1811266646 | Eddie P Johnson IIi, Dmd, PC | Preferred Provider Organization | 2755 Barton Chapel Rd, Augusta, GA 30906 | 2011-12-23 |
| 1366739021 | Kerensa A Cooks | Registered Nurse | 3421 Mike Padgett Highway, Serenity Behavioral Health Systems, Augusta, GA 30906 | 2011-07-01 |
| 1265737423 | Pidcock Chiropractic, Inc. | Chiropractor | 3028 Peach Orchard Rd., Augusta, GA 30906 | 2011-01-20 |
| Find all providers in zip 30906 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942691431 | Vincent Roselli | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2416 Eagle Dr, Augusta, GA 30906-3325 | 2015-02-05 |
| 1861735391 | Beverly Briggs | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3520 Primrose Ct, Augusta, GA 30906-9576 | 2013-04-03 |
| 1821392572 | Renee's Personal Care Home, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1916 Ohio Ave, Augusta, GA 30904-5329 | 2011-01-10 |
| 1700101391 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2006 Country Place Dr, Augusta, GA 30906-8732 | 2010-04-07 |
| 1588995112 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 386 Tower Rd, Augusta, GA 30907-8750 | 2010-01-21 |
| 1881925410 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3461 Camak Dr, Augusta, GA 30909-9433 | 2010-01-21 |
| 1679804215 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2208 Walden Dr, Augusta, GA 30904-6508 | 2010-01-21 |
| 1790016327 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2110 Stevens Rd, Augusta, GA 30906-2058 | 2010-01-21 |
| 1437480035 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 313 S Belair Rd, Augusta, GA 30907-8835 | 2010-01-21 |
| 1366773905 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4027 Wheeler Rd, Augusta, GA 30901 | 2010-01-21 |
| Find all providers in AUGUSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.