Provider Demographics
NPI:1467773820
Name:ALBERT GALLATIN HOME CARE AND HOSPICE SERVICES, L.L.C.
Entity Type:Organization
Organization Name:ALBERT GALLATIN HOME CARE AND HOSPICE SERVICES, L.L.C.
Other - Org Name:AMEDISYS HOSPICE OF PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:2183 MCCLELLANDTOWN ROAD
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15461-2593
Practice Address - Country:US
Practice Address - Phone:724-583-2680
Practice Address - Fax:784-583-2685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBERT GALLATIN HOME CARE AND HOSPICE SERVICES, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-18
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA154499251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101485642 0011Medicaid
PA391544Medicare Oscar/Certification