Provider Demographics
NPI:1497812119
Name:HARRIS ENTERPRISES OF NC, INC
Entity Type:Organization
Organization Name:HARRIS ENTERPRISES OF NC, INC
Other - Org Name:DOING BUSINESS AS: ST MARK'S ROAD CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGETTE
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-460-4072
Mailing Address - Street 1:PO BOX 1803
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151-1803
Mailing Address - Country:US
Mailing Address - Phone:704-460-4072
Mailing Address - Fax:704-484-3098
Practice Address - Street 1:1230 ST MARK'S ROAD CARE HOME
Practice Address - Street 2:
Practice Address - City:CROUSE
Practice Address - State:NC
Practice Address - Zip Code:28033
Practice Address - Country:US
Practice Address - Phone:704-460-4072
Practice Address - Fax:704-484-3098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHCL-036-024310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility