Provider Demographics
NPI:1275164196
Name:ANNIE'S HOUSE, LLC
Entity Type:Organization
Organization Name:ANNIE'S HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ORLANDER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-426-2146
Mailing Address - Street 1:1784 HERITAGE CENTER DR STE 204-H
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3989
Mailing Address - Country:US
Mailing Address - Phone:919-426-2146
Mailing Address - Fax:
Practice Address - Street 1:1784 HERITAGE CENTER DR STE 204-H
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3989
Practice Address - Country:US
Practice Address - Phone:919-426-2146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty