MEDICARE: ANNIE BRANCH HOME INC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1457027914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNIE BRANCH HOME INC

Provider Business Mailing Address
First Line	:	1213 KNOTTY ELM LOOP
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3084
Country	:	US
Telephone Number	:	910-476-8854
Fax Number	:

Provider Business Practice Location Address
First Line	:	1213 KNOTTY ELM LOOP
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3084
Country	:	US
Telephone Number	:	910-476-8854
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DENITRA WARD
Credential	:
Telephone Number	:	910-476-8854

Provider Enumeration Date	:	08/16/2021
Last Update Date	:	08/16/2021

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Directions to “ANNIE BRANCH HOME INC ” Practice Location

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