Provider Demographics
NPI:1982775730
Name:AMEDISYS HOME HEALTH, INC. OF VIRGINIA
Entity Type:Organization
Organization Name:AMEDISYS HOME HEALTH, INC. OF VIRGINIA
Other - Org Name:AMEDISYS HOME HEALTH OF WYTHEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LABORDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:222-292-2031
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 1:340 PEPPERS FERRY RD
Practice Address - Street 2:SUITE B
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2056
Practice Address - Country:US
Practice Address - Phone:276-227-0240
Practice Address - Fax:276-227-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-07371251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1982775730Medicaid
VA497613Medicare Oscar/Certification