Provider Demographics
NPI:1255035549
Name:HARRIS, ERIC C (CCMA, BSHA)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:M
Credentials:CCMA, BSHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 42ND ST S APT F
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7518
Mailing Address - Country:US
Mailing Address - Phone:240-535-7188
Mailing Address - Fax:
Practice Address - Street 1:3720 42ND ST S APT F
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7518
Practice Address - Country:US
Practice Address - Phone:240-535-7188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant