Provider Demographics
NPI:1285637900
Name:PORT HOMECARE SERVICES, INC.
Entity Type:Organization
Organization Name:PORT HOMECARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, ADMINISTRATOR,CEO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-854-2273
Mailing Address - Street 1:5525 S STAPLES ST STE A7
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5359
Mailing Address - Country:US
Mailing Address - Phone:361-854-2273
Mailing Address - Fax:361-854-6419
Practice Address - Street 1:5525 S STAPLES ST STE A7
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5359
Practice Address - Country:US
Practice Address - Phone:361-854-2273
Practice Address - Fax:361-854-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005247251E00000X
TX012597251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024322201Medicaid
TX02432201Medicaid
TX024322201Medicaid