Provider Demographics
NPI:1942416979
Name:HARRIS COMMUNITY CARE INC
Entity Type:Organization
Organization Name:HARRIS COMMUNITY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-263-7764
Mailing Address - Street 1:709 W BURKE ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2709
Mailing Address - Country:US
Mailing Address - Phone:304-263-7764
Mailing Address - Fax:304-263-7330
Practice Address - Street 1:709 W BURKE ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2709
Practice Address - Country:US
Practice Address - Phone:304-263-7764
Practice Address - Fax:304-263-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030906000Medicaid