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General NPI Number Information
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NPI Number | 1285067256
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Entity Type | Organization
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Legal Business Name | HARRIS HOUSE ADULT DAY CARE CENTER
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Dates
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Enumeration Date | 08/14/2013
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Last Update Date | 08/14/2013
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Provider Practice Location Address
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Address Line | 9857 GIBSON AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32208-1213
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Country | US
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Telephone | 904-768-1283
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Fax | 904-768-1180
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Provider Business Mailing Address
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Address Line | 9857 GIBSON AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32208-1213
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Country | US
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Telephone | 904-768-1283
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Fax | 904-768-1180
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Authorized Official
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Title or Position | CEO
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Name | RENEE HARRIS
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Credential |
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Telephone | 904-343-7411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 9014
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License Number State | FL
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