1003861824 NPI number — ACCUMED HOME HEALTH OF GEORGIA LLC

Table of content: (NPI 1003861824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003861824 NPI number — ACCUMED HOME HEALTH OF GEORGIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCUMED HOME HEALTH OF GEORGIA 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:
Provider Other Organization Name Type Code:
6
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:
1003861824
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:
400 CHURCHILL CT
Provider Second Line Business Practice Location Address:
STE 440
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30188-6837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-926-9525
Provider Business Practice Location Address Fax Number:
770-926-9581
Provider Enumeration Date:
05/23/2006

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: 251E00000X , with the licence number:  033263 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 117130 . This is a "HUMANA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000964708F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51862895001 . This is a "BC BS FEDERAL" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 51863111001 . This is a "BC BS FEDERAL" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 51863111002 . This is a "BCBS FED" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52002394 . This is a "BC BS OF GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52002394001 . This is a "BCBS FED" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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