Provider Demographics
NPI:1649422239
Name:TENDER LOVING CARE HEALTH CARE SERVICES OF WEST VIRGINIA, L.L.C.
Entity Type:Organization
Organization Name:TENDER LOVING CARE HEALTH CARE SERVICES OF WEST VIRGINIA, L.L.C.
Other - Org Name:AMEDISYS HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:67 CASINO DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ANMOORE
Practice Address - State:WV
Practice Address - Zip Code:26323
Practice Address - Country:US
Practice Address - Phone:304-622-1297
Practice Address - Fax:304-622-0978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENDER LOVING CARE HEALTH CARE SERVICES OF WEST VIRGINIA, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-15
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19251G00000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000002Medicaid
WV3810017242Medicaid
WV3810019151Medicaid
WV3810017242Medicaid