MEDICARE: DIRTRICE HARRIS

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	163WH0200X	Home Health Registered Nurse	260201201	IN

General Provider Information

NPI Number	:	1972430023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIRTRICE HARRIS

Provider Business Mailing Address
First Line	:	1523 LINCOLN WAY W
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-2419
Country	:	US
Telephone Number	:	574-292-5698
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 LINCOLN WAY W
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-2419
Country	:	US
Telephone Number	:	574-292-5698
Fax Number	:	574-292-5698

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

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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Directions to “ DIRTRICE HARRIS ” Practice Location

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