Provider Demographics
NPI:1821393315
Name:PORT HUMAN SERVICES
Entity Type:Organization
Organization Name:PORT HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:SAVIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-830-7540
Mailing Address - Street 1:4300-110 SAPPHIRE COURT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9019
Mailing Address - Country:US
Mailing Address - Phone:252-830-7540
Mailing Address - Fax:252-413-0932
Practice Address - Street 1:607 #2 NIXON STREET
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3043
Practice Address - Country:US
Practice Address - Phone:910-254-4817
Practice Address - Fax:910-251-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health