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General NPI Number Information
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NPI Number | 1710016951
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Entity Type | Organization
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Legal Business Name | ANNIE L LONG
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/17/2007
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Provider Practice Location Address
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Address Line | 1654 ALLISON RD
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City | YANCEYVILLE
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State | NC
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Zip | 27379-8430
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Country | US
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Telephone | 336-694-9992
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Fax | 336-694-1107
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Provider Business Mailing Address
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Address Line | PO BOX 1112
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City | YANCEYVILLE
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State | NC
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Zip | 27379-1112
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Country | US
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Telephone | 336-694-9992
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Fax | 336-694-1107
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANNIE L LONG
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Credential |
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Telephone | 336-694-9992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL017019
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License Number State | NC
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