Provider Demographics
NPI:1538480751
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 HOME HEALTH 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 1:5959 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:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:2181 MCCLELLAND ROAD
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15461-2042
Practice Address - Country:US
Practice Address - Phone:724-583-0414
Practice Address - Fax:724-583-2085
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:2010-06-22
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA713905251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101485642 0004Medicaid
PA397139Medicare Oscar/Certification