Provider Demographics
NPI:1427612894
Name:PERKINS PARTIAL HOSPITAL PROGRAM, PLLC
Entity type:Organization
Organization Name:PERKINS PARTIAL HOSPITAL PROGRAM, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-276-4804
Mailing Address - Street 1:203 CAPCOM AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6514
Mailing Address - Country:US
Mailing Address - Phone:919-276-4804
Mailing Address - Fax:
Practice Address - Street 1:203 CAPCOM AVE STE 104
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6514
Practice Address - Country:US
Practice Address - Phone:919-276-4804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)