Organization
PORT HEALTH SERVICES
Active
Other names
PORT Human Services
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT BEAVERS (CREDENTIALING MANAGER)
(919) 210-7661
Entity
Organization
Contact information
Practice address
144 COMMUNITY COLLEGE RD STE C, AHOSKIE, NC 27910-8047
(252) 332-5086
(252) 332-5243
Mailing address
4300 SAPPHIRE CT STE 110, GREENVILLE, NC 27834-9079
(252) 830-7540
(252) 413-0932
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
MHL-046-015
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301162
—
NC
Enumeration date
01/17/2007
Last updated
05/15/2023
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