Healthcare Provider Details

I. General information

NPI: 1679310510
Provider Name (Legal Business Name): ANNS LOVE AND CARE HOME LLC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 EVERETT ST
BURLINGTON NC
27215-5903
US

IV. Provider business mailing address

613 EVERETT ST
BURLINGTON NC
27215-5903
US

V. Phone/Fax

Practice location:
  • Phone: 336-518-8455
  • Fax:
Mailing address:
  • Phone: 336-518-8455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHAIKIEMA EVANS
Title or Position: MISS
Credential:
Phone: 336-523-6726