Provider Demographics
NPI:1306978945
Name:PORT CITY OPERATING COMPANY, LLC
Entity type:Organization
Organization Name:PORT CITY OPERATING COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEM CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORISETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-275-8112
Mailing Address - Street 1:PO BOX 213008
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95213-9008
Mailing Address - Country:US
Mailing Address - Phone:858-275-8112
Mailing Address - Fax:779-803-8118
Practice Address - Street 1:509 W WEBER AVE STE 200
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-3107
Practice Address - Country:US
Practice Address - Phone:858-275-8112
Practice Address - Fax:779-803-8118
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORT CITY OPERATING COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-09
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100000166251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ07634ZOtherBLUE SHIELD
651191369OtherIRS
651191369952040002OtherTRICARE
CAZZR07212GMedicaid
ZZZ07634ZOtherBLUE SHIELD