Provider Demographics
NPI:1003515156
Name:HARNESS, ADAM RAY
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:RAY
Last Name:HARNESS
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 1:2505 W SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2250
Mailing Address - Country:US
Mailing Address - Phone:440-989-6683
Mailing Address - Fax:
Practice Address - Street 1:2505 W SKYLINE DR
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2250
Practice Address - Country:US
Practice Address - Phone:440-989-6683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker