Healthcare Provider Details

I. General information

NPI: 1467384792
Provider Name (Legal Business Name): PRENTICE HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 STANTON RD SE
WASHINGTON DC
20020-2283
US

IV. Provider business mailing address

235 MISSISSIPPI AVE SE APT 102
WASHINGTON DC
20032-2468
US

V. Phone/Fax

Practice location:
  • Phone: 202-805-0210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: