Provider Demographics
NPI:1790743961
Name:AMEDISYS HOME HEALTH OF ALABAMA, LLC
Entity Type:Organization
Organization Name:AMEDISYS HOME HEALTH OF ALABAMA, LLC
Other - Org Name:AMEDISYS HOME HEALTH OF CITRONELLE
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 1:19375 N 3RD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CITRONELLE
Practice Address - State:AL
Practice Address - Zip Code:36522-2044
Practice Address - Country:US
Practice Address - Phone:251-866-3261
Practice Address - Fax:251-866-3259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALAME7070AMedicaid
017070Medicare Oscar/Certification