Basic Information
| Provider Information | |||||||||
| NPI: | 1003861824 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ACCUMED HOME HEALTH OF GEORGIA LLC | ||||||||
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| OtherOrganizationName: | COMMUNITY HOME HEALTH, AN AMEDISYS COMPANY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3854 AMERICAN WAY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708164013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252922031 | ||||||||
| FaxNumber: | 2252959678 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 CHURCHILL CT | ||||||||
| Address2: | STE 440 | ||||||||
| City: | WOODSTOCK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301886837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709269525 | ||||||||
| FaxNumber: | 7709269581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 10/03/2016 | ||||||||
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| AuthorizedOfficialLastName: | KUSSEROW | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2252922031 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 033263 | GA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 117130 | 01 | GA | HUMANA | OTHER | 000964708F | 05 | GA | MEDICAID | 51862895001 | 01 | GA | BC BS FEDERAL | OTHER | 51863111001 | 01 | GA | BC BS FEDERAL | OTHER | 51863111002 | 01 | GA | BCBS FED | OTHER | 52002394 | 01 | GA | BC BS OF GA | OTHER | 52002394001 | 01 | GA | BCBS FED | OTHER |