Healthcare Provider Details

I. General information

NPI: 1235306325
Provider Name (Legal Business Name): AMEDISYS FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 N FERDON BLVD
CRESTVIEW FL
32536-2113
US

IV. Provider business mailing address

3854 AMERICAN WAY SUITE A
BATON ROUGE LA
70816-4013
US

V. Phone/Fax

Practice location:
  • Phone: 850-682-1803
  • Fax: 850-628-1831
Mailing address:
  • Phone: 225-292-2031
  • Fax: 225-295-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299992759
License Number StateFL

VIII. Authorized Official

Name: PAUL B KUSSEROW
Title or Position: PRESIDENT
Credential:
Phone: 225-292-2031