Penn 123 LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

PENN 123 LLC

Practice address

4933 Wabash St
Metairie, LA 70001-1031

Phone

(504) 603-3060

NPI assigned

Apr 10, 2023

Organization subpart

No

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

Authorized official

Name

Yehuda Alter

Title

Ceo

Phone

(732) 307-8000

Specialties & licenses 3

Addresses

Other names 1

• Avenues Extended Care at Metairie Doing business as

Tax ID family

Avenues Extended Care at Metairie2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Penn 123 LLC

  • Substance Abuse Rehabilitation Facility
  • Metairie, LA
  • NPI 1932640521
  NPD tax ID

Locations

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

{
    "created_epoch": "1681084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681084800000",
    "number": "1144915786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 BOULEVARD OF THE AMERICAS",
            "address_2": "SUITE 503",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "08701",
            "telephone_number": "732-307-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4933 WABASH ST",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700011031",
            "telephone_number": "504-603-3060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENN 123 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-10",
        "last_updated": "2023-04-10",
        "certification_date": "2023-03-31",
        "status": "A",
        "authorized_official_last_name": "ALTER",
        "authorized_official_first_name": "YEHUDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "732-307-8000"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avenues Extended Care at Metairie",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Pellittieri
• Reine S Pema Sanga
• Kilsy Isabel Pena, RN
• Lawrence Edward Pendleton
• Penelope Treece, Apmc
• Penn 123 LLC
• Candace Penner, PHARM D
• Kailyn Pennington
• Lauren W Pennington, PT
• Peoples Choice Optical LLC

• Substance Use Disorder Rehabilitation Clinic/Center in Metairie, LA
• Providers in Metairie, LA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; 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.