Provider Demographics
NPI:1043258932
Name:HARRIS HEALTH CENTER, LLC
Entity type:Organization
Organization Name:HARRIS HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:H
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:401-434-7404
Mailing Address - Street 1:833 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3722
Mailing Address - Country:US
Mailing Address - Phone:401-434-7404
Mailing Address - Fax:401-435-4255
Practice Address - Street 1:833 BROADWAY
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-3722
Practice Address - Country:US
Practice Address - Phone:401-434-7404
Practice Address - Fax:401-435-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI708314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4105098Medicaid
RI415098Medicare ID - Type Unspecified