=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306727433
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDREA MARIE CARE HOME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2025
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1575 OLD NC 20 RD
-----------------------------------------------------
City | SAINT PAULS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28384-9648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-476-8733
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1575 OLD NC 20 RD
-----------------------------------------------------
City | SAINT PAULS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28384-9648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | FELECIA BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 347-476-8733
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------