Provider Demographics
NPI:1497972897
Name:AMEDISYS GEORGIA LLC
Entity Type:Organization
Organization Name:AMEDISYS GEORGIA LLC
Other - Org Name:CENTRAL HOME HEALTH CARE AN AMEDISYS COMPANY
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:70816-6080
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:300 W BROOME ST
Practice Address - Street 2:STE 108
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3177
Practice Address - Country:US
Practice Address - Phone:706-812-9292
Practice Address - Fax:706-812-9286
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEDISYS GEORGIA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-19
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048-241-H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00824942CMedicaid