Provider Demographics
NPI:1346686714
Name:GEORGE HARRIS
Entity Type:Organization
Organization Name:GEORGE HARRIS
Other - Org Name:GEORGE'S ADULT FAMILY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTROR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-585-0967
Mailing Address - Street 1:152 TORRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-2424
Mailing Address - Country:US
Mailing Address - Phone:941-585-0967
Mailing Address - Fax:
Practice Address - Street 1:152 TORRINGTON ST
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-2424
Practice Address - Country:US
Practice Address - Phone:941-585-0967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906507311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home