Provider Demographics
NPI:1013955194
Name:CENTENNIAL PROFESSIONAL THERAPY SERVICES CORPORATION
Entity Type:Organization
Organization Name:CENTENNIAL PROFESSIONAL THERAPY SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:NURNBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-379-1035
Mailing Address - Street 1:303 PERIMETER CTR N
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-3402
Mailing Address - Country:US
Mailing Address - Phone:770-379-1035
Mailing Address - Fax:770-234-5172
Practice Address - Street 1:303 PERIMETER CTR N
Practice Address - Street 2:SUITE 510
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-3402
Practice Address - Country:US
Practice Address - Phone:770-379-1035
Practice Address - Fax:770-234-5172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA113146332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5603429Medicaid
LA1960161Medicaid
IN200124240AMedicaid
KY90274069Medicaid
AR134440716Medicaid
GA972405883AMedicaid
DC032746100Medicaid
TX076048001Medicaid
ID002106200Medicaid
MS00440076Medicaid
NC7701861Medicaid
TN3563038Medicaid
NMT4208Medicaid
TX076048001Medicaid
MS00440076Medicaid