Organization
PENN 123 LLC
Active
Other names
Avenues Extended Care at Metairie
Organization subpart
No
Provider details
NPI number
Authorized official
YEHUDA ALTER (CEO)
(732) 307-8000
Entity
Organization
Contact information
Practice address
4933 WABASH ST, METAIRIE, LA 70001-1031
(504) 603-3060
Mailing address
211 BOULEVARD OF THE AMERICAS, SUITE 503, LAKEWOOD, NJ 08701
(732) 307-8000
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
04/10/2023
Last updated
04/10/2023
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