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General NPI Number Information
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NPI Number | 1881814150
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Entity Type | Organization
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Legal Business Name | PORT CITY ENTERPRISES, INC.
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 836 N 7TH ST
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City | PORT ALLEN
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State | LA
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Zip | 70767
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Country | US
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Telephone | 225-344-1142
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Fax | 225-344-1192
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Provider Business Mailing Address
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Address Line | 836 NORTH 7TH ST
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City | PORT ALLEN
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State | LA
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Zip | 70767
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Country | US
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Telephone | 225-344-1142
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Fax | 225-344-1192
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CHRISTINE C. DUNLEVY
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Credential |
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Telephone | 225-344-1142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | PCA 4624
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | RC 6081
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | SIL 4589
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | ADC 2263
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License Number State | LA
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