Provider Demographics
NPI:1073944898
Name:AMEDISYS PRIVATE DUTY, LLC
Entity Type:Organization
Organization Name:AMEDISYS PRIVATE DUTY, LLC
Other - Org Name:COMMUNITY CARE SERVICES OF HACKENSACK, AN AMEDISYS & PREMIER PARTNERSH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:TURCHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, MPA
Authorized Official - Phone:914-428-7722
Mailing Address - Street 1:445 HAMILTON AVE
Mailing Address - Street 2:10TH FLOOR
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1807
Mailing Address - Country:US
Mailing Address - Phone:914-428-7722
Mailing Address - Fax:914-428-2404
Practice Address - Street 1:25 E SALEM ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7427
Practice Address - Country:US
Practice Address - Phone:201-880-8923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0182100163WH0200X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJHP0182100OtherLICENSE