=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336197003
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMEDISYS NORTHWEST, L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2006
-----------------------------------------------------
Last Update Date | 03/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 244 ODELL RD UNIT 1
-----------------------------------------------------
City | GRIFFIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30224-4787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-229-4962
-----------------------------------------------------
Fax | 770-412-8767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3854 AMERICAN WAY SUITE A
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70816-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-292-2031
-----------------------------------------------------
Fax | 225-295-9678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP TAX
-----------------------------------------------------
Name | TRAVIS MIGLICCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-299-3803
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 126-278-H
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------