Century 2 Therapy Division Street Center, LLC

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

Legal business name

CENTURY 2 THERAPY DIVISION STREET CENTER, LLC

Practice address

3901 Houma Blvd
Ste 113
Metairie, LA 70006-2930

Phone

(504) 888-1330

Fax

(504) 888-6201

NPI assigned

Jun 23, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Mark Leland Guidry

Title

Ceo

Phone

(504) 293-4000

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023014131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 HOUMA BLVD",
            "address_2": "STE 113",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700062930",
            "telephone_number": "504-888-1330",
            "fax_number": "504-888-6201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 HOUMA BLVD",
            "address_2": "STE 113",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700062930",
            "telephone_number": "504-888-1330",
            "fax_number": "504-888-6201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTURY 2 THERAPY DIVISION STREET CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GUIDRY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "LELAND",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "504-293-4000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "7307358",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1113671",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.