Provider Demographics
NPI:1487823183
Name:AMEDISYS WEST VIRGINIA, L.L.C.
Entity Type:Organization
Organization Name:AMEDISYS WEST VIRGINIA, L.L.C.
Other - Org Name:AMEDISYS HOME HEALTH OF WEST VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
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 1:545 AIRPORT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-7388
Practice Address - Country:US
Practice Address - Phone:304-325-0066
Practice Address - Fax:304-325-0077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEDISYS WEST VIRGINIA, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-27
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVN/A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012503Medicaid
WV3810012503Medicaid