NPIMap

Organization Active NPI

Nine Palms 1, LLC

Doing business as Brookside Home Health, an Amedisys Company

  • Home Health Agency
  • Gloucester, VA
National Provider Identifier
1881846087
Registry record updated May 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
NINE PALMS 1, LLC
Doing business as
Brookside Home Health, an Amedisys Company
Practice address
6606 Main St
Gloucester, VA 23061
Phone
(804) 758-1311
Fax
(804) 758-8817
NPI assigned
Oct 21, 2008
Last updated
May 31, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
NINE PALMS 1, LPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 31, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Paul Kusserow
Title
Ceo
Phone
(225) 292-2031

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

6606 Main St
Gloucester, VA 23061

Mailing address

3854 American Way
Suite a
Baton Rouge, LA 70816-4013
Phone (225) 292-2031

Other identifiers 1

IdentifierTypeStateIssuer
1881846087MedicaidVA

Other names 1

  • Brookside Home Health, an Amedisys Company Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Nine Palms 1 LP3 organizations share this tax ID, including this one
Part of
Nine Palms 1 LP

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527724800000",
    "number": "1881846087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3854 AMERICAN WAY",
            "address_2": "SUITE A",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708164013",
            "telephone_number": "225-292-2031",
            "fax_number": "225-295-9678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6606 MAIN ST",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "23061",
            "telephone_number": "804-758-1311",
            "fax_number": "804-758-8817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NINE PALMS 1, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NINE PALMS 1, LP",
        "enumeration_date": "2008-10-21",
        "last_updated": "2018-05-31",
        "status": "A",
        "authorized_official_last_name": "KUSSEROW",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "225-292-2031",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881846087",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookside Home Health, an Amedisys Company",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brookside Home Health, an Amedisys Company",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gloucester, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.