Provider Demographics
NPI:1245297746
Name:PORTRUSH LLC
Entity type:Organization
Organization Name:PORTRUSH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:RIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-532-1400
Mailing Address - Street 1:7300 STATE HIGHWAY 121 STE 250
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1991
Mailing Address - Country:US
Mailing Address - Phone:903-532-1400
Mailing Address - Fax:602-331-1204
Practice Address - Street 1:14350 N 87TH ST STE 145
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2657
Practice Address - Country:US
Practice Address - Phone:602-331-1100
Practice Address - Fax:602-331-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ175928Medicaid
AZ037162Medicare ID - Type Unspecified