Provider Demographics
NPI:1528356045
Name:HARRISON, CAIRON WADE
Entity type:Individual
Prefix:
First Name:CAIRON
Middle Name:WADE
Last Name:HARRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BICENTENNIAL CIR
Mailing Address - Street 2:277R
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2801
Mailing Address - Country:US
Mailing Address - Phone:916-690-9759
Mailing Address - Fax:866-627-4692
Practice Address - Street 1:100 BICENTENNIAL CIR
Practice Address - Street 2:277R
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2801
Practice Address - Country:US
Practice Address - Phone:916-690-9759
Practice Address - Fax:866-627-4692
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No372600000XNursing Service Related ProvidersAdult Companion