1013955194 NPI number — CENTENNIAL PROFESSIONAL THERAPY SERVICES CORPORATION

Table of content: (NPI 1013955194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013955194 NPI number — CENTENNIAL PROFESSIONAL THERAPY SERVICES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTENNIAL PROFESSIONAL THERAPY SERVICES CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013955194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 PERIMETER CTR N
Provider Second Line Business Mailing Address:
SUITE 510
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30346-3402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-379-1035
Provider Business Mailing Address Fax Number:
770-234-5172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 PERIMETER CTR N
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30346-3402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-379-1035
Provider Business Practice Location Address Fax Number:
770-234-5172
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NURNBERG
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
770-379-1035

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X , with the licence number:  113146 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5603429 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1960161 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200124240A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90274069 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 134440716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 972405883A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 032746100 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 076048001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002106200 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00440076 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7701861 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3563038 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: T4208 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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