Organization
NINE PALMS 2 LLC
Active
Other names
Tender Loving Care, an Amedisys Company
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL KUSSEROW (PRESIDENT)
(225) 292-2031
Entity
Organization
Contact information
Practice address
11010 HIGHWAY 49, STE 4, GULFPORT, MS 39503-4190
(228) 831-9821
(228) 831-9826
Mailing address
3854 AMERICAN WAY, SUITE A, BATON ROUGE, LA 70816-4013
(225) 292-2031
(225) 295-9678
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
12384
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000070507
BC BS OF MS
MS
01
—
000070508
BC BS OF MS FED
MS
05
—
00770616
—
MS
Enumeration date
05/23/2006
Last updated
09/06/2017
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