Healthcare Provider Details

I. General information

NPI: 1730795576
Provider Name (Legal Business Name): MAKISHA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAKISHA HARRIS

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10405 GRACE AVE
GARFIELD HTS OH
44125-2651
US

IV. Provider business mailing address

PO BOX 25541
GARFIELD HTS OH
44125-0541
US

V. Phone/Fax

Practice location:
  • Phone: 330-840-1105
  • Fax:
Mailing address:
  • Phone: 330-840-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number1831485
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number1831485
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: