Provider Demographics
NPI:1538285317
Name:ANN'S FAMILY CARE HOME
Entity Type:Organization
Organization Name:ANN'S FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CRANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-790-7663
Mailing Address - Street 1:4406 OLD WAKE FOREST RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-2527
Mailing Address - Country:US
Mailing Address - Phone:919-790-7663
Mailing Address - Fax:919-790-7139
Practice Address - Street 1:4406 OLD WAKE FOREST RD
Practice Address - Street 2:214
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-2527
Practice Address - Country:US
Practice Address - Phone:919-790-7663
Practice Address - Fax:919-790-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-092-084311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home