MEDICARE: HUMANITARIAN EMERGENCY LIFE PROGRAM, 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1417256892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMANITARIAN EMERGENCY LIFE PROGRAM, INC

Provider Business Mailing Address
First Line	:	3126 MILTON RD STE 235
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3782
Country	:	US
Telephone Number	:	704-831-8227
Fax Number	:

Provider Business Practice Location Address
First Line	:	3126 MILTON RD STE 235
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3782
Country	:	US
Telephone Number	:	704-831-8227
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/PRESIDENT
Name	:	MR. JEREMIAH AUGUSTINE HARRIS SR.
Credential	:
Telephone Number	:	980-216-9462

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	03/24/2011

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