Basic Information
| Provider Information | |||||||||
| NPI: | 1205803525 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CRISP HOME CARE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 910 N 5TH ST | ||||||||
| Address2: | |||||||||
| City: | CORDELE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310153254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292719686 | ||||||||
| FaxNumber: | 2292719689 | ||||||||
| Practice Location | |||||||||
| Address1: | 910 N 5TH ST | ||||||||
| Address2: | |||||||||
| City: | CORDELE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310153254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292719686 | ||||||||
| FaxNumber: | 2292719689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SARATSIOTIS | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
| AuthorizedOfficialMiddleName: | BRIDGES | ||||||||
| AuthorizedOfficialTitleorPosition: | PATIENT ACCOUNTING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2292719686 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 040R0003 | GA | Y | Agencies | Home Health |
No ID Information.