Provider Demographics
NPI:1629808498
Name:HARRISON, SADE R (CNA)
Entity type:Individual
Prefix:MRS
First Name:SADE
Middle Name:R
Last Name:HARRISON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 BRIARLEAF CIR
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-8492
Mailing Address - Country:US
Mailing Address - Phone:843-909-3426
Mailing Address - Fax:
Practice Address - Street 1:152 BRIARLEAF CIR
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-8492
Practice Address - Country:US
Practice Address - Phone:843-909-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC161466251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health