Provider Demographics
NPI:1114118759
Name:AMEDISYS SP-OH, L.L.C.
Entity Type:Organization
Organization Name:AMEDISYS SP-OH, L.L.C.
Other - Org Name:AMEDISYS HOME HEALTH OF MIDDLETOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:301 N BREIEL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3868
Practice Address - Country:US
Practice Address - Phone:513-705-0398
Practice Address - Fax:513-705-0378
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEDISYS SP-OH, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-08
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-150184251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2632806Medicaid
OH397559Medicare Oscar/Certification