Organization
NINE PALMS 1, LLC
Active
Parent organization
NINE PALMS 1, LP
Other names
Brookside Home Health, an Amedisys Company
Organization subpart
Yes
Provider details
NPI number
Legal business name
NINE PALMS 1, LP
Authorized official
MR. PAUL KUSSEROW (CEO)
(225) 292-2031
Entity
Organization
Contact information
Practice address
6606 MAIN ST, GLOUCESTER, VA 23061
(804) 758-1311
(804) 758-8817
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881846087
—
VA
Enumeration date
10/21/2008
Last updated
05/31/2018
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