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Organization
PORTVILLE GROUP
Active
Organization
PORTVILLE GROUP
Active
Parent organization
PORTVILLE GROUP
Other names
Portville Home Care Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
PORTVILLE GROUP
Authorized official
YUSUFF OMOTAYO KAZZIM (CHIEF EXECUTIVE OFFICER)
(323) 636-7944
Entity
Organization
Contact information
Practice address
5568 HANNIBAL CT, DENVER, CO 80239-5696
(323) 636-7944
Mailing address
5568 HANNIBAL CT, DENVER, CO 80239-5696
(323) 636-7944
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
—
NULL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
376J00000X
Homemaker
—
NULL
376J00000X
Homemaker
—
—
385H00000X
Respite Care
—
NULL
Other
Enumeration date
11/14/2019
Last updated
12/09/2020
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