MEDICARE: SANNI ENTERPRISE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1184439895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANNI ENTERPRISE LLC

Provider Business Mailing Address
First Line	:	4006 NORTHERLY ISLAND CT
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28056-6341
Country	:	US
Telephone Number	:	980-248-9079
Fax Number	:

Provider Business Practice Location Address
First Line	:	1312 LINEBERGER AVE
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-0717
Country	:	US
Telephone Number	:	980-248-9079
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ASHLEY K SANNI
Credential	:
Telephone Number	:	980-248-9079

Provider Enumeration Date	:	02/10/2025
Last Update Date	:	01/21/2026

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Directions to “SANNI ENTERPRISE LLC ” Practice Location

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