Provider Demographics
NPI:1366600256
Name:AMEDISYS WEST VIRGINIA, L.L.C.
Entity type:Organization
Organization Name:AMEDISYS WEST VIRGINIA, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
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:225-298-9678
Practice Address - Street 1:2200 GRAND CENTRAL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-1300
Practice Address - Country:US
Practice Address - Phone:304-424-6270
Practice Address - Fax:304-424-6274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21315D00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810017240Medicaid
WV3810019171Medicaid
WV3810011798Medicaid
WV3810019171Medicaid