MEDICARE: MAKISHA 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	171M00000X	Case Manager/Care Coordinator
2	343900000X	Non-emergency Medical Transport (VAN)	1831485	OH
3	3747P1801X	Personal Care Attendant	1831485	OH

General Provider Information

NPI Number	:	1730795576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKISHA HARRIS

Provider Business Mailing Address
First Line	:	PO BOX 25541
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-0541
Country	:	US
Telephone Number	:	330-840-1105
Fax Number	:

Provider Business Practice Location Address
First Line	:	10405 GRACE AVE
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-2651
Country	:	US
Telephone Number	:	330-840-1105
Fax Number	:

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

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	07/24/2023

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Directions to “ MAKISHA HARRIS ” Practice Location

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