Provider Demographics
NPI:1013284314
Name:PERENNIAL HEALTH SERVICES PLC
Entity Type:Organization
Organization Name:PERENNIAL HEALTH SERVICES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:DARRIN
Authorized Official - Last Name:CARDE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-633-7203
Mailing Address - Street 1:233 FULTON ST E
Mailing Address - Street 2:SUITE 114
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3200
Mailing Address - Country:US
Mailing Address - Phone:616-633-7203
Mailing Address - Fax:616-427-3023
Practice Address - Street 1:233 E FULTON ST
Practice Address - Street 2:SUITE 114
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3200
Practice Address - Country:US
Practice Address - Phone:616-633-7203
Practice Address - Fax:616-427-3023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010215361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION72660Medicare PIN