ANNIE L LONG (NPI# 1154450591) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154450591 |
| Entity Type | Organization |
| Organization Name | ANNIE L LONG |
| Other Organization Name | SHOMARI FAMILY CARE |
| Practice Address |
3879 Hodges Dairy Rd Yanceyville NC 27379-8430 |
| Mailing Address |
Po Box 1112 Yanceyville NC 27379-1112 |
| Practice Telephone | 3366949994 |
| Practice Fax Number | 3366941107 |
| Mailing Telephone | 3366949994 |
| Mailing Fax Number | 3366941107 |
| Enumeration Date | 2007-03-03 |
| Last Update Date | 2007-08-17 |
| Authorized Official Name | MRS. ANNIE L LONG (OWNER) |
| Authorized Official Telephone | 3366949994 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
FCL017021 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7801386 | 05 |
| Other Name | Type Code |
|---|---|
| Shomari Family Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710016951 | Annie L Long | Custodial Care Facility | 1654 Allison Rd, Yanceyville, NC 27379-8430 | 2007-03-05 |
| 1255460259 | Annie L Long | Custodial Care Facility | 591 Marshall Graves Rd, Yanceyville, NC 27379-8600 | 2007-03-05 |
| Street Address |
3879 HODGES DAIRY RD |
| City | YANCEYVILLE |
| State | NC |
| Zip Code | 27379-8430 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700079357 | Shomari Family Care Home | Custodial Care Facility | 3879 Hodges Dairy Rd, Yanceyville, NC 27379-8430 | 2007-08-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144861337 | The Caswell Family Medical Center, Inc. | Clinic/Center | 649 Firetower Rd, Yanceyville, NC 27379 | 2019-09-30 |
| 1295399079 | Life Beyond The Shadows Counseling, Pllc | Counselor | 110 1st St., Yanceyville, NC 27379 | 2019-04-26 |
| 1942781836 | Connect3 Healthcare Services LLC | Counselor | 1088 Nc Hwy 86n, Yanceyville, NC 27379 | 2018-08-28 |
| 1124514633 | Piedmont Triad Regional Council | Community/Behavioral Health | 649 Firetower Road, Yanceyville, NC 27379 | 2018-07-09 |
| 1154855302 | James Millner IIi | Pharmacist | 1493 Main Street, Yanceyville, NC 27379 | 2017-04-14 |
| 1386182202 | Anya Tilly | Occupational Therapist | 1086 Main St, Yanceyville, NC 27379 | 2017-02-11 |
| 1871044412 | Jennifer Lynn Hambright | Social Worker | 110 Cole St, Yanceyville, NC 27379 | 2016-10-19 |
| 1114325347 | Ariel Community Care, LLC | Counselor | 200 E. Church St, Yanceyville, NC 27379 | 2014-12-22 |
| 1851645550 | Tanillya Wilkerson Partridge | Nurse Practitioner | 293 Main Street, Yanceyille, NC 27379 | 2012-11-01 |
| 1831474337 | Thomas P Davis | Pharmacist | 539 E Main St, Yanceyville, NC 27379 | 2011-10-15 |
| Find all providers in zip 27379 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366659427 | Robert Jones | Custodial Care Facility | 278 East Main St, Yanceyville, NC 27379 | 2007-05-17 |
| 1689794323 | Tamela Blackwell | Custodial Care Facility | 3592 Marshall Graves Rd, Yanceyville, NC 27379-8630 | 2007-03-29 |
| 1215055215 | Terry Care Home | Custodial Care Facility | 2446 Cherry Grove Rd, Yanceyville, NC 27379-8385 | 2007-03-27 |
| 1295854933 | Jefferson Care Home | Custodial Care Facility | 181 Staley Boswell Rd, Yanceyville, NC 27379-8386 | 2007-03-27 |
| 1710016951 | Annie L Long | Custodial Care Facility | 1654 Allison Rd, Yanceyville, NC 27379-8430 | 2007-03-05 |
| 1255460259 | Annie L Long | Custodial Care Facility | 591 Marshall Graves Rd, Yanceyville, NC 27379-8600 | 2007-03-05 |
| 1992025316 | Mildred Blackwell | Custodial Care Facility | 3592 Marshall Graves Rd, Yanceyville, NC 27379-8630 | 2010-06-08 |
| 1699969204 | Annie Parker Long | Custodial Care Facility | 1654 Allison Rd, Yanceyville, NC 27379-8430 | 2007-08-28 |
| 1770777369 | New Begining | Custodial Care Facility | 591 Marshall Graves Rd, Yanceyville, NC 27379-8600 | 2007-08-28 |
| 1700079357 | Shomari Family Care Home | Custodial Care Facility | 3879 Hodges Dairy Rd, Yanceyville, NC 27379-8430 | 2007-08-27 |
| Find all providers in YANCEYVILLE | ||||
| City | YANCEYVILLE |
| Zip Code | 27379 |
Please comment or provide details below to improve the information on ANNIE L LONG.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.