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PORT HEALTH SERVICES NPI 1194874925


NPI Information

NPI: 1194874925
Provider Name: PORT HEALTH SERVICES

Former Legal Business Name: PORT HUMAN SERVICES

Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization

CLIA Number: 34D1058848

Address:
501 PALADIN DR
GREENVILLE, NC
ZIP 27834
Phone: (252) 353-5346
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PORT HEALTH SERVICES is a community behavioral health in Greenville, NC. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. PORT HEALTH SERVICES NPI is 1194874925. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is Port Human Services.

The provider's business location address is:

501 PALADIN DR
GREENVILLE, NC
ZIP 27834-826
Phone: (252) 353-5346
Fax: (252) 321-7300

The provider's authorized official is Brett Beavers .
The authorized official title is Credentialing Manager and has the following contact phone number (919) 210-7661.

The CLIA number assigned to this NPI record is 34D1058848 - comp. outpatient rehab facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/10/2007 and was last updated on 5/15/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1101YA0400XCounselorAddiction (Substance Use Disorder)MHL-074-146NORTH CAROLINANo
2251S00000XCommunity/Behavioral HealthYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
18300231MEDICAIDNORTH CAROLINA
26005329MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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