Provider Demographics
NPI:1871523902
Name:AMEDISYS LOUISIANA, LLC
Entity type:Organization
Organization Name:AMEDISYS LOUISIANA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:425 ASHLEY RIDGE BLVD
Practice Address - Street 2:SUITE 246
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7226
Practice Address - Country:US
Practice Address - Phone:318-865-8865
Practice Address - Fax:318-865-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203781752251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
013100POtherLA-COMMERCIAL NUMBER
1018198OtherLA-COMMERCIAL NUMBER
113414024GOtherLA-COMMERCIAL NUMBER
LA1696251Medicaid
LA1696251 F23Medicaid
33939OtherLA-COMMERCIAL NUMBER
LA569549Medicaid
115712OtherLA-COMMERCIAL NUMBER
565800OtherLA-COMMERCIAL NUMBER
LA1962309Medicaid
112645333028OtherLA-CHAMPUS
LA1903086Medicaid
197242OtherLA-COMMERCIAL NUMBER
LA1962317Medicaid
LA1069027Medicaid
112645333OtherLA-COMMERCIAL NUMBER
112645333148OtherLA-CHAMPUS
LA1402346Medicaid
6000182OtherLA-COMMERCIAL NUMBER
LA569549Medicaid