Healthcare Provider Details

I. General information

NPI: 1255035549
Provider Name (Legal Business Name): ERIC C HARRIS CCMA, BSHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4357 13TH AVE S STE 107
FARGO ND
58103-7506
US

IV. Provider business mailing address

3230 SETER PKWY S APT 207
FARGO ND
58104-7822
US

V. Phone/Fax

Practice location:
  • Phone: 701-997-9157
  • Fax:
Mailing address:
  • Phone: 240-535-7188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: