NPIMap

Organization Active NPI

Perkins Partial Hospital Program, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wake Forest, NC
National Provider Identifier
1427612894
Registry record updated Jun 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
PERKINS PARTIAL HOSPITAL PROGRAM, PLLC
Doing business as
Bright Path Behavioral Health
Perkins PHP
Practice address
203 Capcom Ave Ste 104
Wake Forest, NC 27587-6514
Phone
(919) 276-4804
NPI assigned
Apr 30, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Shantel Sullivan
Title
Ceo
Phone
(919) 276-4804

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

203 Capcom Ave Ste 104
Wake Forest, NC 27587-6514

Mailing address

203 Capcom Ave Ste 104
Wake Forest, NC 27587-6514
Phone (919) 276-4804

Other names 2

  • Bright Path Behavioral Health Doing business as
  • Perkins PHP Doing business as

National Provider Directory

National Provider Directory

Locations

203 Capcom Ave
Ste 104
Wake Forest, NC 27587
Phone (919) 276-4005

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1427612894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 CAPCOM AVE STE 104",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275876514",
            "telephone_number": "919-276-4804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 CAPCOM AVE STE 104",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275876514",
            "telephone_number": "919-276-4804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERKINS PARTIAL HOSPITAL PROGRAM, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-30",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "SHANTEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-276-4804",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bright Path Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Perkins PHP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Perkins PHP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wake Forest, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.