MEDICARE: ANITA'S HOUSE OF HOPE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1649158387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANITA'S HOUSE OF HOPE LLC

Provider Business Mailing Address
First Line	:	PO BOX 16
Second Line	:
City	:	MC LEANSVILLE
State	:	NC
Zip	:	27301-0016
Country	:	US
Telephone Number	:	888-508-6711
Fax Number	:

Provider Business Practice Location Address
First Line	:	614 DOUGLAS ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-1709
Country	:	US
Telephone Number	:	888-508-6711
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	MRS. PORCHA MOORE GARY
Credential	:
Telephone Number	:	336-580-9836

Provider Enumeration Date	:	08/21/2025
Last Update Date	:	10/08/2025

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Directions to “ANITA'S HOUSE OF HOPE LLC ” Practice Location

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