Provider Demographics
NPI:1770800369
Name:AMEDISYS HOSPICE, LLC
Entity type:Organization
Organization Name:AMEDISYS HOSPICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:2761 ALBRIGHT RD
Practice Address - Street 2:BUILDING B
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3996
Practice Address - Country:US
Practice Address - Phone:765-864-0134
Practice Address - Fax:765-864-0182
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEDISYS HOSPICE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-22
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN080113431251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200873260BMedicaid
IN200873260BMedicaid