Organization
ANN'S COUNTRY MANOR
Active
Parent organization
CRANDELLS ENTERPRISES
Organization subpart
Yes
Provider details
NPI number
Legal business name
CRANDELLS ENTERPRISES
Authorized official
MS. SANDRA MAYO (COO)
(919) 790-7663
Entity
Organization
Contact information
Practice address
5312 SIX FORKS RD STE 301, RALEIGH, NC 27609-4458
(919) 790-7663
(919) 790-6990
Mailing address
105 AVERY ST, GARNER, NC 27529-3133
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL-092-861
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804626
—
NC
Enumeration date
06/25/2014
Last updated
03/08/2021
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