Organization · Type 2 NPI

Portville Group

Intellectual and/or Developmental Disabilities Residential Treatment Facility · Denver, CO

NPI number 1821633702 Active

Practice location

5568 Hannibal Ct
Denver, CO 80239-5696

Specialties and licenses

Taxonomy	Code	License
Developmentally Disabled Services Day Training Agency	251C00000X	None listed
In Home Supportive Care Agency	253Z00000X	None listed
Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary	320600000X	None listed
Homemaker	376J00000X	None listed
Respite Care	385H00000X	None listed

Intellectual and/or Developmental Disabilities Residential Treatment Facility: A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

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NPI record

NPI: 1821633702
Entity type: Organization (Type 2)
Issued: Nov 14, 2019
Last updated: Dec 9, 2020
Status: Active
Subpart: Yes of Portville Group

Other names

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Portville Home Care Services · doing business as

Authorized official

Yusuff Omotayo Kazzim
Chief Executive Officer
(323) 636-7944

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1821633702

Portville Group's National Provider Identifier is 1821633702, issued on Nov 14, 2019. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Residential Treatment Facility (320600000X), and the practice location is in Denver, CO. The record was last updated on Dec 9, 2020.