Provider Demographics
NPI:1124180609
Name:AMEDISYS INDIANA, LLC
Entity Type:Organization
Organization Name:AMEDISYS INDIANA, LLC
Other - Org Name:AMEDISYS HOME HEALTH OF MUNSTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
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:225-298-3548
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:931 RIDGE RD
Practice Address - Street 2:SUITES E & F
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1755
Practice Address - Country:US
Practice Address - Phone:219-836-4979
Practice Address - Fax:219-836-4976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010149251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN157521Medicare Oscar/Certification