Provider Demographics
NPI:1023247780
Name:AMEDISYS PENNSYLVANIA, L.L.C
Entity type:Organization
Organization Name:AMEDISYS PENNSYLVANIA, 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 1:1605 N CEDAR CREST BLVD
Practice Address - Street 2:SUITE 509
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2351
Practice Address - Country:US
Practice Address - Phone:610-776-6370
Practice Address - Fax:610-776-6375
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEDISYS PENNSYLVANIA, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-02
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA016505251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020418560005Medicaid
PA397780Medicare Oscar/Certification