Healthcare Provider Details

I. General information

NPI: 1710223847
Provider Name (Legal Business Name): PERPETUAL HOME HEALTH CARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 GROVE ST
RANDOLPH MA
02368-2949
US

IV. Provider business mailing address

30 GROVE ST
RANDOLPH MA
02368-2949
US

V. Phone/Fax

Practice location:
  • Phone: 857-234-1146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DOMINIQUE B GELIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 857-234-1146