Healthcare Provider Details

I. General information

NPI: 1285597864
Provider Name (Legal Business Name): HARRISON LIMITED LIABILITY CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 CONESTOGA WAY
SAN JOSE CA
95123-4215
US

IV. Provider business mailing address

1612 DIXIE DR
SAN JOSE CA
95122-2505
US

V. Phone/Fax

Practice location:
  • Phone: 510-921-8892
  • Fax:
Mailing address:
  • Phone: 510-921-8892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JOCELLE HARRISON
Title or Position: ADMINISTRATOR
Credential:
Phone: 510-921-8892