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
2602 COURTIER DR, GREENVILLE, NC 27834-7818
(252) 752-0483
(252) 757-3172
Mailing address
4300 SAPPHIRE CT STE 110, GREENVILLE, NC 27834-9079
(252) 830-7540
(252) 413-0932
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
MHL-074-157
NC
251S00000X
Community/Behavioral Health Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
MHL-074-145
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016X5
BCBS PROVIDER NUMBER
NC
05
—
5900726
—
NC
05
—
5900727
—
NC
05
—
6005329
—
NC
05
—
6005332
—
NC
05
—
6005334
—
NC
05
—
6005592
—
NC
05
—
6005597
—
NC
05
—
6603789
—
NC
05
—
6603790
—
NC
Enumeration date
12/14/2005
Last updated
05/24/2023
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