- Enrollment id
- O20080311000296
- Enrollment state
- GA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1285682955
- Multiple npi flag
- N
- Ccn
- 117041
- Associate id
- 2264342823
- Organization name
- AMEDISYS GEORGIA, L.L.C.
- Doing business as name
- COOSA VALLEY HOME HEALTH, AN AMEDISYS COMPANY
- Incorporation date
- 2002-08-01
- Incorporation state
- GA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 800 BROAD ST
- Address line 2
- STE 202
- City
- ROME
- State
- GA
- Zip code
- 301613140