Provider Demographics
NPI:1700024353
Name:AMEDISYS NORTH DAKOTA LLC
Entity Type:Organization
Organization Name:AMEDISYS NORTH DAKOTA LLC
Other - Org Name:AMEDISYS HOME HEALTH OF FARGO
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:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-298-3548
Mailing Address - Fax:
Practice Address - Street 1:4666 AMBER VALLEY PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8612
Practice Address - Country:US
Practice Address - Phone:701-277-3091
Practice Address - Fax:701-277-3591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PENDING251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDPENDINGMedicare Oscar/Certification