Provider Demographics
NPI:1003861824
Name:ACCUMED HOME HEALTH OF GEORGIA LLC
Entity Type:Organization
Organization Name:ACCUMED HOME HEALTH OF GEORGIA LLC
Other - Org Name:COMMUNITY HOME HEALTH, AN AMEDISYS COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUSSEROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:400 CHURCHILL CT
Practice Address - Street 2:STE 440
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6837
Practice Address - Country:US
Practice Address - Phone:770-926-9525
Practice Address - Fax:770-926-9581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033263251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA117130OtherHUMANA
GA000964708FMedicaid
GA51862895001OtherBC BS FEDERAL
GA51863111001OtherBC BS FEDERAL
GA51863111002OtherBCBS FED
GA52002394OtherBC BS OF GA
GA52002394001OtherBCBS FED
GA51862895001OtherBC BS FEDERAL
GA52002394OtherBC BS OF GA
GA=========OtherBS BS OF VA ANTHEM
GA=========OtherHARTFORD INSURANCE
GA=========OtherSOUTHCARE
GA=========OtherCOVENTRY HEALTH CARE
GA=========OtherCORESOURCE
GA000964708FMedicaid
GA=========OtherCORAM HEALTHCARE
GA=========OtherAETNA US HEALTHCARE
GA117130OtherHUMANA
GA117130Medicare Oscar/Certification