Healthcare Provider Details

I. General information

NPI: 1164605101
Provider Name (Legal Business Name): AMEDISYS PUERTO RICO, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CALLE 1 SUITE 303
GUAYNABO PR
00968-1760
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 787-762-0889
  • Fax: 787-752-6481
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 Number50
License Number StatePR

VIII. Authorized Official

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