Provider Demographics
NPI:1578006094
Name:THE PERISCOPE GROUP
Entity Type:Organization
Organization Name:THE PERISCOPE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA
Authorized Official - Phone:866-886-9992
Mailing Address - Street 1:548 MARKET ST # 75842
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-5401
Mailing Address - Country:US
Mailing Address - Phone:866-886-9992
Mailing Address - Fax:866-871-5895
Practice Address - Street 1:548 MARKET ST # 75842
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-5401
Practice Address - Country:US
Practice Address - Phone:866-886-9992
Practice Address - Fax:866-871-5895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18893251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health