Healthcare Provider Details

I. General information

NPI: 1891488896
Provider Name (Legal Business Name): AMEDISYS HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5447 MAPLE LN STE A
FAYETTEVILLE WV
25840-6872
US

IV. Provider business mailing address

5447 MAPLE LN STE A
FAYETTEVILLE WV
25840-6872
US

V. Phone/Fax

Practice location:
  • Phone: 304-574-1141
  • Fax: 304-574-1151
Mailing address:
  • Phone: 304-574-1141
  • Fax: 304-574-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LISA EDWARDS
Title or Position: LPN/SKILLED NURSE
Credential: LPN
Phone: 304-573-6120