Provider Demographics
NPI:1003810615
Name:HARRIS, BEVERLY ANN (CEO)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:MS
Other - First Name:B
Other - Middle Name:A
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8706 CONTEE RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1939
Mailing Address - Country:US
Mailing Address - Phone:301-498-1001
Mailing Address - Fax:301-498-1001
Practice Address - Street 1:8706 CONTEE RD
Practice Address - Street 2:SUITE 13
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1939
Practice Address - Country:US
Practice Address - Phone:301-498-1001
Practice Address - Fax:301-498-1001
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744R1103X
MD374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder
Not Answered374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC032173OtherNONE