Provider Demographics
NPI:1053508556
Name:PORT CITY ENTERPRISES, INC.
Entity Type:Organization
Organization Name:PORT CITY ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUNLEVY
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:225-344-1142
Mailing Address - Street 1:P.O. BOX 113
Mailing Address - Street 2:836 N. 7TH ST
Mailing Address - City:PORT ALLEN,
Mailing Address - State:LA
Mailing Address - Zip Code:70767
Mailing Address - Country:US
Mailing Address - Phone:225-344-1142
Mailing Address - Fax:225-344-1192
Practice Address - Street 1:836 N. SEVENTH ST
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767
Practice Address - Country:US
Practice Address - Phone:225-344-1142
Practice Address - Fax:225-344-1192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4624385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1686638Medicaid