NPIMap

Organization Active NPI

Port Health Services

  • Children's Substance Abuse Rehabilitation Facility
  • Greenville, NC
National Provider Identifier
1396897161
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X
License
MHL-074-111 Issued in NC
Legal business name
PORT HEALTH SERVICES
Practice address
114 Health Drive
Greenville, NC 27834-7826
Phone
(252) 413-1965
Fax
(252) 413-0500
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brett Beavers
Title
Credentialing Manager
Phone
(919) 210-7661

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X
Children's Substance Abuse Rehabilitation Facility 3245S0500X MHL-074-111 NC Primary

Addresses

Primary practice location

114 Health Drive
Greenville, NC 27834-7826

Mailing address

4300 Sapphire CT Ste 110
Greenville, NC 27834-9079
Phone (252) 830-7540

Other names 1

  • PORT Human Services Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Port Health Services38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1396897161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 SAPPHIRE CT STE 110",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278349079",
            "telephone_number": "252-830-7540",
            "fax_number": "252-413-0932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 HEALTH DRIVE",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278347826",
            "telephone_number": "252-413-1965",
            "fax_number": "252-413-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-15",
        "status": "A",
        "authorized_official_last_name": "BEAVERS",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "919-210-7661"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "NC",
            "license": "MHL-074-111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PORT Human Services",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "PORT Human Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Greenville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.