1447205315 NPI number — PERPETUAL HEALTH CLINIC, INC.

Table of content: (NPI 1447205315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447205315 NPI number — PERPETUAL HEALTH CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERPETUAL HEALTH CLINIC, INC.
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:
1447205315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1467 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
ATHOL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01331-2652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-249-9736
Provider Business Mailing Address Fax Number:
978-249-3922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1467 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
ATHOL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01331-2652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-249-9736
Provider Business Practice Location Address Fax Number:
978-249-3922
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FUNA
Authorized Official First Name:
DANILO
Authorized Official Middle Name:
TOLENTINO
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
978-249-9736

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: W10097102 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA50132 . This is a "HARVARD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 24262 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M19127 . This is a "BLUECROSSBLUESHIELDS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 080233 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1197895 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3132929 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97195701 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com