Provider Demographics
NPI:1588665541
Name:PERNET FAMILY HEALTH SERVICE, INC.
Entity Type:Organization
Organization Name:PERNET FAMILY HEALTH SERVICE, INC.
Other - Org Name:PERNET FAMILY HEALTHY SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BS,RN
Authorized Official - Phone:508-755-1228
Mailing Address - Street 1:237 MILLBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2177
Mailing Address - Country:US
Mailing Address - Phone:508-755-1228
Mailing Address - Fax:508-797-3477
Practice Address - Street 1:237 MILLBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2177
Practice Address - Country:US
Practice Address - Phone:508-755-1228
Practice Address - Fax:508-797-3477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227162251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0601799Medicaid
613315OtherTUFTS HEALTH PLAN
0007224OtherNEIGHBORHOOD HEALTH PLAN
6460OtherFALLON
626094OtherHARVARD PILGRIM
EI0005OtherBLUECROSS/BLUESHIELD
MA1802992Medicaid