Provider Demographics
NPI:1881835619
Name:MARY REBECCA HOME INCORPORATED
Entity Type:Organization
Organization Name:MARY REBECCA HOME INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, QMHP
Authorized Official - Phone:910-482-3513
Mailing Address - Street 1:PO BOX 9729
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9091
Mailing Address - Country:US
Mailing Address - Phone:910-482-3513
Mailing Address - Fax:910-482-3571
Practice Address - Street 1:8138 TURKEY HWY
Practice Address - Street 2:
Practice Address - City:TURKEY
Practice Address - State:NC
Practice Address - Zip Code:28393-8463
Practice Address - Country:US
Practice Address - Phone:910-482-3513
Practice Address - Fax:910-482-3571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health