Organization
PORT SOUTH VILLAGE
Active
Organization
PORT SOUTH VILLAGE
Active
Other names
Port South Village
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BUDDY LOCKAMY (ADMINISTRATOR)
(910) 814-1223
Entity
Organization
Contact information
Practice address
210 COVIL AVE, WILMINGTON, NC 28403-0711
(910) 814-1223
(910) 814-1223
Mailing address
PO BOX 4669, WILMINGTON, NC 28406-1669
(910) 814-1223
(910) 814-1223
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
HAL- 065-606
NC
310400000X
Assisted Living Facility
HAL-065-005
NC
310400000X
Assisted Living Facility
HAL-065-007
NC
310400000X
Assisted Living Facility
Primary
HAL-065-008
NC
310400000X
Assisted Living Facility
HAL-065-009
NC
310400000X
Assisted Living Facility
HAL-065-010
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7801041
—
NC
05
—
7801042
—
NC
05
—
7801043
—
NC
05
—
7801156
—
NC
05
—
7801157
—
NC
05
—
7801395
—
NC
Enumeration date
03/28/2007
Last updated
08/22/2020
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