Provider Demographics
NPI:1861711368
Name:AMEDISYS IDAHO, L.L.C.
Entity type:Organization
Organization Name:AMEDISYS IDAHO, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LABORDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:
Practice Address - Street 1:1480 MIDWAY AVENUE
Practice Address - Street 2:UNIT 7
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-4587
Practice Address - Country:US
Practice Address - Phone:208-523-1980
Practice Address - Fax:208-523-4024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPRES HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-24
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1861711368002Medicaid
ID1861711368002Medicaid