Provider Demographics
NPI:1699944546
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: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:225-298-3548
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:500 WESTMORELAND PARK OFC CENTER
Practice Address - Street 2:SUITE 101A
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-2732
Practice Address - Country:US
Practice Address - Phone:304-766-8093
Practice Address - Fax:304-766-8934
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEDISYS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-25
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV381002502Medicaid
WV381002502Medicaid