MEDICARE: STACY HARRIS HOME CARE AGENCY

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	374U00000X	Home Health Aide	11793601	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467088757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY HARRIS HOME CARE AGENCY

Provider Business Mailing Address
First Line	:	900 S ARLINGTON AVE RM 144B
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17109-5030
Country	:	US
Telephone Number	:	717-370-4976
Fax Number	:	717-412-7390

Provider Business Practice Location Address
First Line	:	900 S ARLINGTON AVE RM 144B
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17109-5030
Country	:	US
Telephone Number	:	717-370-4976
Fax Number	:	717-412-7390

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	03/18/2020

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