OrganizationAnn'S Country ManorCommunity/Behavioral HealthAgenciesPractice Address5312 Six Forks Rd Ste 301, Raleigh, NC 27609-4458(919) 790-7663PECOS EnrollmentBased on the most recent information from CMS, provider Ann'S Country Manor does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1558776948Provider TypeOrganizationFull NameAnn'S Country ManorSubpartYesEnumeration Date6/25/2014Last Updated3/8/2021Contact InformationPractice LocationPractice Address5312 Six Forks Rd Ste 301, Raleigh, NC 27609-4458Phone(919) 790-7663Fax(919) 790-6990Mailing LocationMailing Address105 Avery St, Garner, NC 27529-3133PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameMayo, Sandra (Coo)Phone(919) 790-7663Provider TaxonomiesCodeDescriptionLicenseCode251S00000XPrimaryDescriptionCommunity/Behavioral HealthAgenciesLicenseMHL-092-861North CarolinaProvider IdentifiersIDDescriptionIssuerID7804626DescriptionMedicaidIssuerUnlistedNorth Carolina