MEDICARE: MRS. DEBORA LIZ HARRISON RCFE LICENCEE

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	3747P1801X	Personal Care Attendant	RCFE# 585002011	CA

General Provider Information

NPI Number	:	1427217793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORA LIZ HARRISON RCFE LICENCEE

Provider Business Mailing Address
First Line	:	PO BOX 59
Second Line	:
City	:	BROWNSVILLE
State	:	CA
Zip	:	95919-0059
Country	:	US
Telephone Number	:	530-675-3640
Fax Number	:

Provider Business Practice Location Address
First Line	:	8787 MYSTIC MINE TRAIL
Second Line	:
City	:	BROWNSVILLE
State	:	CA
Zip	:	95919
Country	:	US
Telephone Number	:	530-675-3640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/08/2008

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