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General NPI Number Information
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NPI Number | 1932454675
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Entity Type | Organization
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Legal Business Name | ANIYA'S HEART HOME CARE AGENCY, INC.
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 24464 PEACOCK RD
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City | TABOR CITY
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State | NC
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Zip | 28463-7086
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Country | US
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Telephone | 910-840-1453
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Fax |
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Provider Business Mailing Address
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Address Line | 24464 PEACOCK RD
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City | TABOR CITY
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State | NC
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Zip | 28463-7086
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Country | US
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Telephone | 910-840-1453
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | VERONICA LUCRETIA BUTLER
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Credential | BSN, RN
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Telephone | 910-840-1453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HC4555
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License Number State | NC
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