Provider Demographics
NPI:1568059210
Name:HARRIS, JAJCEN T
Entity Type:Individual
Prefix:
First Name:JAJCEN
Middle Name:T
Last Name:HARRIS
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 1:1349 VILLA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2901
Mailing Address - Country:US
Mailing Address - Phone:216-235-3697
Mailing Address - Fax:
Practice Address - Street 1:1349 VILLA DR
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2901
Practice Address - Country:US
Practice Address - Phone:216-235-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide