| NPI | 1396897161 |
|---|---|
| Former Legal Business Name | PORT HUMAN SERVICES |
| Entity Type | Organization |
| Authorized Contact | BRETT BEAVERS Credentialing Manager 919-210-7661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: NC MHL-074-111) |
| Additional Taxonomies | 251S00000X |
| 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2023-05-24 |