MEDICARE: GEORGE HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	6906507	FL

General Provider Information

NPI Number	:	1346686714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE HARRIS

Provider Business Mailing Address
First Line	:	152 TORRINGTON ST
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-2424
Country	:	US
Telephone Number	:	941-585-0967
Fax Number	:

Provider Business Practice Location Address
First Line	:	152 TORRINGTON ST
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-2424
Country	:	US
Telephone Number	:	941-585-0967
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTROR
Name	:	MR. GEORGE HARRIS
Credential	:
Telephone Number	:	941-585-0967

Provider Enumeration Date	:	05/13/2013
Last Update Date	:	05/13/2013

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