| Port City Operating Company, Llc | |
|
510 E Magnolia St Ste 100 Stockton CA 95202-1850 | |
| (209) 461-2054 | |
| Not Available |
| Full Name | Port City Operating Company, Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 510 E Magnolia St Ste 100, Stockton, California |
| Authorized Official Name and Position | Andrea Nicole Ochoa (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2094676442 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Port City Operating Company, Llc 510 E Magnolia St Ste 100 Stockton CA 95202-1850 Ph: (209) 461-2054 | Port City Operating Company, Llc 510 E Magnolia St Ste 100 Stockton CA 95202-1850 Ph: (209) 461-2054 |
| NPI Number | 1679395990 |
|---|---|
| Provider Enumeration Date | 10/28/2024 |
| Last Update Date | 10/28/2024 |
| Certification Date | 10/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679395990 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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