Basic Information
Provider Information
NPI: 1427258714
EntityType: 2
ReplacementNPI:  
OrganizationName: AMEDISYS ARIZONA, L.L.C.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: AMEDISYS HOME HEALTH
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5959 S SHERWOOD FOREST BLVD
Address2:  
City: BATON ROUGE
State: LA
PostalCode: 708166038
CountryCode: US
TelephoneNumber: 2252922031
FaxNumber: 2252959678
Practice Location
Address1: 2185 W PECOS RD
Address2: SUITE E1
City: CHANDLER
State: AZ
PostalCode: 852244873
CountryCode: US
TelephoneNumber: 4808839295
FaxNumber: 4808839252
Other Information
ProviderEnumerationDate: 07/24/2007
LastUpdateDate: 07/10/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BORNE
AuthorizedOfficialFirstName: WILLIAM
AuthorizedOfficialMiddleName: F
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 2252922031
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251E00000XHHA3390AZY AgenciesHome Health 

ID Information
IDTypeStateIssuerDescription
32736405AZ MEDICAID


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