Provider Demographics
NPI:1942350053
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:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:SAVIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-752-0483
Mailing Address - Street 1:2245 STANTONSBURG RD
Mailing Address - Street 2:SUITE P
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2868
Mailing Address - Country:US
Mailing Address - Phone:252-752-0483
Mailing Address - Fax:252-752-2971
Practice Address - Street 1:2115 FOREST HILLS RD W STE A
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3483
Practice Address - Country:US
Practice Address - Phone:252-237-1037
Practice Address - Fax:252-237-2190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905305Medicaid
NC016X5OtherBCBS
NC6005921Medicaid
NC8301623Medicaid