1891765723 NPI number — FAMILY HOME HEALTH CARE LLC

Table of content: (NPI 1891765723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891765723 NPI number — FAMILY HOME HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HOME HEALTH CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMEDISYS HOME HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891765723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3854 AMERICAN WAY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-4013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-292-2031
Provider Business Mailing Address Fax Number:
225-295-9678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
937 CAMPBELLSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 903
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42728-2265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-384-6411
Provider Business Practice Location Address Fax Number:
270-384-3928
Provider Enumeration Date:
01/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KUSSEROW
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
225-292-2031

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  150108 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 150108 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X , with the licence number: 105129 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 150108 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 45344280 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111571 . This is a "CAREMARK INC PROVIDER ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100162920 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100162950 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1059740 . This is a "PASSPORT PROVIDER ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 34004010 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100162880 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42010017 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100162960 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1166978 . This is a "CHA HEALTH PROVIDER ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000054994 . This is a "BLUE CROSS PROVIDER ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 41100033 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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