Provider Demographics
NPI:1942069091
Name:PORTCITYPARTYBUS LLC
Entity Type:Organization
Organization Name:PORTCITYPARTYBUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:D
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-420-2681
Mailing Address - Street 1:729 JUNIPERO SERRA DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-1154
Mailing Address - Country:US
Mailing Address - Phone:209-420-2681
Mailing Address - Fax:
Practice Address - Street 1:729 JUNIPERO SERRA DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-1154
Practice Address - Country:US
Practice Address - Phone:209-420-2681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No347C00000XTransportation ServicesPrivate Vehicle