=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730480534
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMEDISYS NEW HAMPSHIRE, L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2010
-----------------------------------------------------
Last Update Date | 12/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 NEW HAMPSHIRE AVE SUITE 270
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801-2841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-436-0815
-----------------------------------------------------
Fax | 603-431-5457
-----------------------------------------------------
=====================================================
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 | PRESIDENT
-----------------------------------------------------
Name | PAUL B KUSSEROW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-292-2031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 03314
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 03147
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 38023
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 38240
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------