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General NPI Number Information
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NPI Number | 1699056382
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Entity Type | Organization
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Legal Business Name | BELLE PORT INC
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Dates
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Enumeration Date | 09/08/2011
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Last Update Date | 09/08/2011
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Provider Practice Location Address
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Address Line | 275 PAMLICO ST
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City | BELHAVEN
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State | NC
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Zip | 27810-1417
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Country | US
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Telephone | 252-943-2656
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Fax | 252-944-2828
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Provider Business Mailing Address
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Address Line | 275 PAMLICO ST
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City | BELHAVEN
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State | NC
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Zip | 27810-1417
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Country | US
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Telephone | 252-943-2656
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Fax | 252-944-2828
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALTON PRENTISS ONEAL III
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Credential | PHARMD
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Telephone | 252-943-1913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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