Organization Name: | PERPETUAL HEALTH CLINIC, INC. |
NPI Number: | 1447205315 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANILO TOLENTINO FUNA (PRESIDENT / CEO) |
Mailing Address: | 1467 Main St Suite 2 Athol |
State: | MA US |
Postal Code: | 013312652 |
Phone Number: | 9782499736 |
Fax Number: | 9782493922 |
NPI Enumeration Date: | 05/22/2006 |
NPI Last Update Date: | 10/31/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |