Healthcare Provider Details

I. General information

NPI: 1437212081
Provider Name (Legal Business Name): HARRIS FRANK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HARRISBURG CARE CENTER 1000 WEST SLOAN ST
HARRISBURG IL
62946
US

IV. Provider business mailing address

1145 HEMBREE RD
ROSWELL GA
30076-1122
US

V. Phone/Fax

Practice location:
  • Phone: 618-252-0351
  • Fax: 618-253-4308
Mailing address:
  • Phone: 770-650-8773
  • Fax: 770-650-9732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0045799
License Number StateIL

VIII. Authorized Official

Name: TYGH BROGDON
Title or Position: MANAGER
Credential:
Phone: 770-650-8773