Provider Demographics
NPI:1891410890
Name:HARRIS, ALFREDA
Entity Type:Individual
Prefix:
First Name:ALFREDA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37421
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32315-7421
Mailing Address - Country:US
Mailing Address - Phone:850-508-6724
Mailing Address - Fax:850-216-2733
Practice Address - Street 1:4585 OLD BAINBRIDGE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-7603
Practice Address - Country:US
Practice Address - Phone:850-765-0072
Practice Address - Fax:850-216-2733
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility