Organization
GEORGE ANNA HOUSE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TONI N JOHNSON O (OWNER)
(757) 224-6852
Entity
Organization
Contact information
Practice address
1081 OLD ALLENSVILLE RD, ROXBORO, NC 27574-9562
(336) 599-8534
Mailing address
5109 GOLDSBORO DR APT 21B, HAMPTON, VA 23605-1343
(757) 310-1117
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL 073-045
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409542
—
NC
05
—
7804803
—
NC
Enumeration date
08/22/2007
Last updated
08/29/2007
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