MEDICARE: HARRIS CARE CENTERS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility		MO

General Provider Information

NPI Number	:	1043407158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRIS CARE CENTERS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 675
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-0675
Country	:	US
Telephone Number	:	573-760-9376
Fax Number	:	573-760-9386

Provider Business Practice Location Address
First Line	:	381 ELM ST
Second Line	:
City	:	SAINT MARY
State	:	MO
Zip	:	63673-9330
Country	:	US
Telephone Number	:	573-543-2218
Fax Number	:	573-543-2262

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ELANE JOHNSON
Credential	:
Telephone Number	:	573-760-9376

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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