Provider Demographics
NPI:1821220328
Name:ANNIE'S HOUSE OF LOVE
Entity Type:Organization
Organization Name:ANNIE'S HOUSE OF LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME MAMAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAULS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-281-1281
Mailing Address - Street 1:408 PINECREST DR W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3422
Mailing Address - Country:US
Mailing Address - Phone:252-315-3515
Mailing Address - Fax:252-291-6962
Practice Address - Street 1:103 BELMONT AVE SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4701
Practice Address - Country:US
Practice Address - Phone:252-218-1281
Practice Address - Fax:252-291-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-098-135310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility