Provider Demographics
NPI:1538964374
Name:PORTAL HEALTH LLC
Entity type:Organization
Organization Name:PORTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ZELBESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-961-0844
Mailing Address - Street 1:28 HADDINGTON RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5719
Mailing Address - Country:US
Mailing Address - Phone:410-961-0844
Mailing Address - Fax:
Practice Address - Street 1:7939 HONEYGO BLVD STE 208
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-5992
Practice Address - Country:US
Practice Address - Phone:410-961-0844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service