Provider Demographics
NPI:1780923136
Name:PERKINS ENTERPRISES, INC.
Entity type:Organization
Organization Name:PERKINS ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:507-269-0424
Mailing Address - Street 1:2247 68TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8862
Mailing Address - Country:US
Mailing Address - Phone:507-529-1758
Mailing Address - Fax:
Practice Address - Street 1:1700 N BROADWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-4144
Practice Address - Country:US
Practice Address - Phone:507-529-1758
Practice Address - Fax:507-289-1536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10475093CDT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health