Provider Demographics
NPI:1154652428
Name:AMEDISYS HOSPICE, LLC
Entity Type:Organization
Organization Name:AMEDISYS HOSPICE, LLC
Other - Org Name:AMEDISYS HOSPICE CARE
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 1:56 THREE HUNTS DR
Practice Address - Street 2:BUILDING 3
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8998
Practice Address - Country:US
Practice Address - Phone:910-521-8211
Practice Address - Fax:910-521-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
NCHC4027251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1154652428Medicaid
NC3411596Medicaid
NC341596Medicare Oscar/Certification