Basic Information
| Provider Information | |||||||||
| NPI: | 1275783839 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AMEDISYS WASHINGTON, L.L.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AMEDISYS HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 S SHERWOOD FOREST BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708166038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252922031 | ||||||||
| FaxNumber: | 2252929678 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 JASMINE ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | OMAK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988419501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094228621 | ||||||||
| FaxNumber: | 5094220131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2008 | ||||||||
| LastUpdateDate: | 11/29/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BORNE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| 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 | 251G00000X | IHSF60077040 | WA | Y | Agencies | Hospice Care, Community Based |
No ID Information.