Provider Demographics
NPI:1457542003
Name:AMEDISYS SP-OH, L.L.C.
Entity type:Organization
Organization Name:AMEDISYS SP-OH, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:3600 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE A, BUILDING 480
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3437
Practice Address - Country:US
Practice Address - Phone:614-273-1420
Practice Address - Fax:614-273-1421
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEDISYS SP-OH, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-08
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2861989Medicaid
OH2861989Medicaid