Provider Demographics
NPI:1598719379
Name:ALBERT GALLATIN HOME CARE AND HOSPICE SERVICES, LLC
Entity Type:Organization
Organization Name:ALBERT GALLATIN HOME CARE AND HOSPICE SERVICES, LLC
Other - Org Name:AMEDISYS HOME HEALTH OF PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:U
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-299-3701
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 1:1368 MALL RUN RD
Practice Address - Street 2:SUITE 628
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2696
Practice Address - Country:US
Practice Address - Phone:724-438-6660
Practice Address - Fax:724-438-3868
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:2006-05-19
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA713905251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA254340OtherHEALTH AMERICA PA
PA212057OtherUPMC HEALTH PLAN
PA1014856420014Medicaid
PA162461OtherTHREE RIVERS HEALTH PLAN
PA201031840034OtherTRICARE
PA0757OtherBCBS
PA1014856420005Medicaid
PA60634820OtherFEDERAL BLACK LUNG
PA1014856420001Medicaid
PA1014856420002Medicaid
PA1014856420004Medicaid
PA1069189OtherWORKERS' COMP
PA1014856420012Medicaid
PA201031840034OtherTRICARE