Provider Demographics
NPI:1821750605
Name:PORTERS HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:PORTERS HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TITILOLA
Authorized Official - Middle Name:OLUWATOSIN
Authorized Official - Last Name:ADEWALE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:412-855-0102
Mailing Address - Street 1:8712 NELLIE LN
Mailing Address - Street 2:
Mailing Address - City:MARVIN
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7944
Mailing Address - Country:US
Mailing Address - Phone:980-729-3366
Mailing Address - Fax:
Practice Address - Street 1:8712 NELLIE LN
Practice Address - Street 2:
Practice Address - City:MARVIN
Practice Address - State:NC
Practice Address - Zip Code:28173-7944
Practice Address - Country:US
Practice Address - Phone:980-729-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-09
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care