Healthcare Provider Details

I. General information

NPI: 1053443473
Provider Name (Legal Business Name): PORT CITY OPERATING COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 N CALIFORNIA ST
STOCKTON CA
95204-5502
US

IV. Provider business mailing address

PO BOX 213008
STOCKTON CA
95213-9008
US

V. Phone/Fax

Practice location:
  • Phone: 858-275-8112
  • Fax: 779-803-8118
Mailing address:
  • Phone: 858-275-8112
  • Fax: 779-803-8118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number030000367
License Number StateCA

VIII. Authorized Official

Name: DANIEL MORISETTE
Title or Position: SYSTEM CHIEF FINANCIAL OFFICER
Credential:
Phone: 858-275-8112