Provider Demographics
NPI:1902264799
Name:PORT CITY PERSONAL CARE SERVICES LLC
Entity Type:Organization
Organization Name:PORT CITY PERSONAL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-580-5221
Mailing Address - Street 1:424 HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-4901
Mailing Address - Country:US
Mailing Address - Phone:662-580-5221
Mailing Address - Fax:662-796-0611
Practice Address - Street 1:424 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4901
Practice Address - Country:US
Practice Address - Phone:662-580-5221
Practice Address - Fax:662-796-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty