Provider Demographics
NPI:1558600866
Name:PORTEE, ARIMETA
Entity Type:Individual
Prefix:MS
First Name:ARIMETA
Middle Name:
Last Name:PORTEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5227 OLD RAILROAD WAY
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-7841
Mailing Address - Country:US
Mailing Address - Phone:910-425-0572
Mailing Address - Fax:910-425-3015
Practice Address - Street 1:5227 OLD RAILROAD WAY
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-7841
Practice Address - Country:US
Practice Address - Phone:910-425-0572
Practice Address - Fax:910-425-3015
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-026-939320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities