NPIMap

Organization Active NPI

Ann'S Country Manor

  • Community/Behavioral Health Agency
  • Raleigh, NC
National Provider Identifier
1558776948
Registry record updated Mar 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL-092-861 Issued in NC
Legal business name
ANN'S COUNTRY MANOR
Practice address
5312 Six Forks Rd Ste 301
Raleigh, NC 27609-4458
Phone
(919) 790-7663
Fax
(919) 790-6990
NPI assigned
Jun 25, 2014
Organization subpart
Yes
Parent organization
CRANDELLS ENTERPRISESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 8, 2021

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

Authorized official

Name
Ms. Sandra Mayo
Title
Coo
Phone
(919) 790-7663

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MHL-092-861 NC Primary

Addresses

Primary practice location

5312 Six Forks Rd Ste 301
Raleigh, NC 27609-4458

Mailing address

105 Avery St
Garner, NC 27529-3133

Other identifiers 1

IdentifierTypeStateIssuer
7804626MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Crandell'S Enterprise'S Inc4 organizations share this tax ID, including this one
Part of
Crandell'S Enterprise'S Inc

Other organizations with this tax ID 3

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

Locations

105 Avery St
Garner, NC 27529
Phone (919) 900-8918

NPI Registry JSON

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

{
    "created_epoch": "1403654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615161600000",
    "number": "1558776948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 AVERY ST",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275293133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5312 SIX FORKS RD STE 301",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276094458",
            "telephone_number": "919-790-7663",
            "fax_number": "919-790-6990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANN'S COUNTRY MANOR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRANDELLS ENTERPRISES",
        "enumeration_date": "2014-06-25",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A",
        "authorized_official_last_name": "MAYO",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "919-790-7663",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL-092-861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804626",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2021; 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.