Provider Demographics
NPI:1992173744
Name:HARRIS, EDIE (PCA/CHHA)
Entity type:Individual
Prefix:
First Name:EDIE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PCA/CHHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 WATERVLIET SHAKER RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-0309
Mailing Address - Country:US
Mailing Address - Phone:518-461-3969
Mailing Address - Fax:
Practice Address - Street 1:358 WATERVLIET SHAKER RD UNIT A
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189
Practice Address - Country:US
Practice Address - Phone:518-833-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2018-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00248381374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide