NPIMap

Organization Active NPI

Annie L Long

  • Adult Care Home Facility
  • Yanceyville, NC
National Provider Identifier
1154450591
Registry record updated Aug 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
FCL017021 Issued in NC
Legal business name
ANNIE L LONG
Practice address
3879 Hodges Dairy Rd
Yanceyville, NC 27379-8430
Phone
(336) 694-9994
Fax
(336) 694-1107
NPI assigned
Mar 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Annie L Long
Title
Owner
Phone
(336) 694-9994

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X FCL017021 NC Primary

Addresses

Primary practice location

3879 Hodges Dairy Rd
Yanceyville, NC 27379-8430

Mailing address

PO Box 1112
Yanceyville, NC 27379-1112
Phone (336) 694-9994

Other identifiers 1

IdentifierTypeStateIssuer
7801386MedicaidNC

Other names 1

  • Shomari Family Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Annie L Long6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187308800000",
    "number": "1154450591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1112",
            "city": "YANCEYVILLE",
            "state": "NC",
            "postal_code": "273791112",
            "telephone_number": "336-694-9994",
            "fax_number": "336-694-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3879 HODGES DAIRY RD",
            "city": "YANCEYVILLE",
            "state": "NC",
            "postal_code": "273798430",
            "telephone_number": "336-694-9994",
            "fax_number": "336-694-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANNIE L LONG",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-03",
        "last_updated": "2007-08-17",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "ANNIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-694-9994",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "FCL017021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7801386",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shomari Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yanceyville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.