<Unavail>

LBN: Port South Village
<Unavail> is an health care organization with primary practice located at 210 Covil Ave , Wilmington NC 28403-0711. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Assisted Living Facility, which is considered as the primary health care specialty. Port South Village can be contacted via phone (910) 814-1223, or through Lockamy, Buddy via phone (910) 814-1223.

Contact Information

Primary practice address
210 Covil Ave Wilmington NC 28403-0711
Phone: (910) 814-1223
Fax: (910) 814-1223
Website:
Map and Directions
Authorized official contact:
Name: Lockamy, Buddy
Phone: (910) 814-1223

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X HAL- 065-606 North Carolina
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X HAL-065-005 North Carolina
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X HAL-065-008 North Carolina
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X HAL-065-009 North Carolina
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X HAL-065-010 North Carolina
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X HAL-065-007 North Carolina

Profile Details

NPI number 1285753269
LBN Legal business name Port South Village
DBA Doing business as <Unavail>
Authorized official Lockamy, Buddy
Entity Organization
Organization subpart 1 No
Enumeration date Mar 28th, 2007
Last updated Aug 22nd, 2020 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285753269 NPPES
North Carolina MEDICAID 7801157
North Carolina MEDICAID 7801156
North Carolina MEDICAID 7801395
North Carolina MEDICAID 7801042
North Carolina MEDICAID 7801043
North Carolina MEDICAID 7801041

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