Provider Demographics
NPI:1619570165
Name:HARPER, HOLACE DANIEL MORRIS
Entity Type:Individual
Prefix:
First Name:HOLACE
Middle Name:DANIEL MORRIS
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 1:1355 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-4431
Mailing Address - Country:US
Mailing Address - Phone:419-606-9505
Mailing Address - Fax:
Practice Address - Street 1:528 EDGEHILL AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4114
Practice Address - Country:US
Practice Address - Phone:419-606-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0301415253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0301415Medicaid