Healthcare Provider Details

I. General information

NPI: 1972826345
Provider Name (Legal Business Name): AMEDISYS MARYLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WEST RD SUITE 212
TOWSON MD
21204-2331
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-8810
  • Fax: 410-825-8815
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 NumberHH7108
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier407725300
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name: WILLIAM F BORNE
Title or Position: CEO
Credential:
Phone: 225-292-2031