Healthcare Provider Details

I. General information

NPI: 1013284314
Provider Name (Legal Business Name): PERENNIAL HEALTH SERVICES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E FULTON ST SUITE 114
GRAND RAPIDS MI
49503-3200
US

IV. Provider business mailing address

233 FULTON ST E SUITE 114
GRAND RAPIDS MI
49503-3200
US

V. Phone/Fax

Practice location:
  • Phone: 616-633-7203
  • Fax: 616-427-3023
Mailing address:
  • Phone: 616-633-7203
  • Fax: 616-427-3023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801021536
License Number StateMI

VIII. Authorized Official

Name: GILBERT DARRIN CARDE
Title or Position: CHIEF EXECUTIVE CLINICIAN
Credential: LMSW
Phone: 616-633-7203