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
114 HEALTH DRIVE, GREENVILLE, NC 27834-7826
(252) 413-1965
(252) 413-0500
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
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
MHL-074-111
NC
Other
Enumeration date
01/18/2007
Last updated
05/24/2023
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