Provider Demographics
NPI:1982822623
Name:AMEDISYS NORTHWEST, L.L.C.
Entity Type:Organization
Organization Name:AMEDISYS NORTHWEST, L.L.C.
Other - Org Name:AMEDISYS NORTHWEST HOME HEALTH
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 1:111 MOUNTAIN VISTA BLVD
Practice Address - Street 2:SUITE 145
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-4272
Practice Address - Country:US
Practice Address - Phone:770-345-3630
Practice Address - Fax:770-345-3655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEDISYS NORTHWEST, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-20
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA112-095251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00208007HMedicaid
GA11Q7064002OtherBRANCH ID
GA117064Medicare Oscar/Certification