Provider Demographics
NPI:1972808152
Name:HARRIS, SENTHAN
Entity Type:Individual
Prefix:
First Name:SENTHAN
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 1:108 E SOUTH ST
Mailing Address - Street 2:P.O. BOX 351
Mailing Address - City:HOLLANDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38748-3834
Mailing Address - Country:US
Mailing Address - Phone:662-827-2211
Mailing Address - Fax:662-827-5766
Practice Address - Street 1:108 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:HOLLANDALE
Practice Address - State:MS
Practice Address - Zip Code:38748-3834
Practice Address - Country:US
Practice Address - Phone:662-827-2211
Practice Address - Fax:662-827-5766
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1073908679Medicaid
MS1295955185Medicaid
MS1821398389Medicaid
MS1972808152Medicaid