Provider Demographics
NPI:1447205315
Name:PERPETUAL HEALTH CLINIC, INC.
Entity Type:Organization
Organization Name:PERPETUAL HEALTH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANILO
Authorized Official - Middle Name:TOLENTINO
Authorized Official - Last Name:FUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-249-9736
Mailing Address - Street 1:1467 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-2652
Mailing Address - Country:US
Mailing Address - Phone:978-249-9736
Mailing Address - Fax:978-249-3922
Practice Address - Street 1:1467 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-2652
Practice Address - Country:US
Practice Address - Phone:978-249-9736
Practice Address - Fax:978-249-3922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERPETUAL HEALTH CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-22
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW10097102OtherCIGNA
MAAA50132OtherHARVARD
MA24262OtherFALLON
MAM19127OtherBLUECROSSBLUESHIELDS
MA080233OtherTUFTS
MA1197895OtherAETNA
MA3132929Medicaid
MA97195701OtherNETWORK HEALTH
MAM19127OtherBLUECROSSBLUESHIELDS
MAW10097102OtherCIGNA