Provider Demographics
NPI:1295361434
Name:HARRIS, RAVEN H (CHHA)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:H
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CHHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 TERRIER DR APT G
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-2100
Mailing Address - Country:US
Mailing Address - Phone:330-808-5339
Mailing Address - Fax:
Practice Address - Street 1:1338 TERRIER DR APT G
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-2100
Practice Address - Country:US
Practice Address - Phone:330-808-5339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide