Provider Demographics
NPI:1003523382
Name:HARRIS, LYDIA (HOMECARE PROVIDER)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:HOMECARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 KINGSTOWNE VILLAGE PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5882
Mailing Address - Country:US
Mailing Address - Phone:703-718-3551
Mailing Address - Fax:703-417-9931
Practice Address - Street 1:5901 KINGSTOWNE VILLAGE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5882
Practice Address - Country:US
Practice Address - Phone:703-718-3551
Practice Address - Fax:703-417-9931
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-212420251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1962037838Medicaid