Provider Demographics
NPI:1871399287
Name:HARRIS, GRACIE JO I
Entity type:Individual
Prefix:MISS
First Name:GRACIE
Middle Name:JO
Last Name:HARRIS
Suffix:I
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 FIDDLER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:NE
Mailing Address - Zip Code:68741-3024
Mailing Address - Country:US
Mailing Address - Phone:402-922-1003
Mailing Address - Fax:
Practice Address - Street 1:1600 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776
Practice Address - Country:US
Practice Address - Phone:402-494-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care