Provider Demographics
NPI:1508295569
Name:HARPER, TERRY
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:HARPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 THRESHOLD CT
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-1144
Mailing Address - Country:US
Mailing Address - Phone:702-202-0323
Mailing Address - Fax:702-549-2677
Practice Address - Street 1:4304 THRESHOLD CT
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-1144
Practice Address - Country:US
Practice Address - Phone:702-202-0323
Practice Address - Fax:702-549-2677
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-10
Last Update Date:2013-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20131646653311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home