Provider Demographics
NPI:1285067256
Name:HARRIS HOUSE ADULT DAY CARE CENTER
Entity type:Organization
Organization Name:HARRIS HOUSE ADULT DAY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-343-7411
Mailing Address - Street 1:9857 GIBSON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-1213
Mailing Address - Country:US
Mailing Address - Phone:904-768-1283
Mailing Address - Fax:904-768-1180
Practice Address - Street 1:9857 GIBSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-1213
Practice Address - Country:US
Practice Address - Phone:904-768-1283
Practice Address - Fax:904-768-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9014385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687233600Medicaid