Organization Name: | HOME PORT THERAPY |
NPI Number: | 1740460872 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | REYNARD BULLOCK (OWNER) |
Mailing Address: | 23 North Rd Ste A25 Peace Dale |
State: | RI US |
Postal Code: | 028792176 |
Phone Number: | 4019321181 |
Fax Number: | 4017831154 |
NPI Enumeration Date: | 11/06/2007 |
NPI Last Update Date: | 11/06/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0850X |
License Number: | MFT00100 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | RI |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Adult Mental Health |
Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |