Healthcare Provider Details

I. General information

NPI: 1003140583
Provider Name (Legal Business Name): PORT HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 AVON AVENUE
WASHINGTON NC
27889-3841
US

IV. Provider business mailing address

4300 SAPPHIRE COURT STE 110
GREENVILLE NC
27834-9019
US

V. Phone/Fax

Practice location:
  • Phone: 252-948-1413
  • Fax: 252-946-1086
Mailing address:
  • Phone: 252-830-7560
  • Fax: 252-413-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: THOMAS O. SAVIDGE
Title or Position: CEO
Credential:
Phone: 252-830-7560