Provider Demographics
NPI:1629015250
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 HOSPICE OF PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
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 1:1368 MALL RUN RD
Practice Address - Street 2:SUITE 624
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2696
Practice Address - Country:US
Practice Address - Phone:724-439-4440
Practice Address - Fax:724-438-2072
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBERT GALLATIN HOME CARE AND HOSPICE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA154499251G00000X
PA17261601251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014856420011Medicaid
PA1019517OtherGATEWAY HEALTH PLAN
PA108176OtherUPMC HEALTH PLAN
PA212057OtherUPMC HEALTH PLAN
PA1028OtherBC FEDERAL
PA162461OtherTHREE RIVERS HEALTH PLANS
PA1014856420015Medicaid
PA757OtherPA HIGHMARK BCBS
PW1014856420006Medicaid
PA1014856420010Medicaid
PA162463OtherTHREE RIVERS HEALTH PLANS
PA1014856420007Medicaid
PA1014856420009Medicaid
PA1014856420013Medicaid
PA254540OtherHEALTH AMERICA PA
PA606348200OtherFEDERAL BLACK LUNG
PA606348200OtherFEDERAL BLACK LUNG