Healthcare Provider Details

I. General information

NPI: 1255598231
Provider Name (Legal Business Name): HARRIS PERSONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 S LIBERTY ST
BASTROP LA
71220-4623
US

IV. Provider business mailing address

148 S LIBERTY ST
BASTROP LA
71220-4623
US

V. Phone/Fax

Practice location:
  • Phone: 318-283-7572
  • Fax: 318-283-7573
Mailing address:
  • Phone: 318-283-7572
  • Fax: 318-283-7573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7477
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number7477
License Number State

VIII. Authorized Official

Name: MRS. MINNIE HARRIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 318-283-7572