Basic Information
Provider Information | |||||||||
NPI: | 1194046557 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ALBERT GALLATIN HOME CARE AND HOSPICE SERVICES, L.L.C. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | AMEDISYS HOSPICE OF PA | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
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: | 100 STOOPS DR | ||||||||
Address2: | SUITE 300 | ||||||||
City: | MONONGAHELA | ||||||||
State: | PA | ||||||||
PostalCode: | 150633553 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7244834109 | ||||||||
FaxNumber: | 7244834015 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/18/2010 | ||||||||
LastUpdateDate: | 09/20/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KUSSEROW | ||||||||
AuthorizedOfficialFirstName: | PAUL | ||||||||
AuthorizedOfficialMiddleName: | B | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 2252922031 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | ALBERT GALLATIN HOME CARE AND HOSPICE SERVICES, L.L.C. | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 154499 | PA | Y |   | Agencies | Hospice Care, Community Based |   |
ID Information
ID | Type | State | Issuer | Description | 101485642 0009 | 05 | PA |   | MEDICAID |