Provider Demographics
NPI:1871387951
Name:GINNIE MAE RESIDENCE CARE LLC
Entity type:Organization
Organization Name:GINNIE MAE RESIDENCE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEDRA
Authorized Official - Middle Name:ANTONELLE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-984-8683
Mailing Address - Street 1:650 N MAIN ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-5018
Mailing Address - Country:US
Mailing Address - Phone:678-984-8683
Mailing Address - Fax:
Practice Address - Street 1:650 N MAIN ST APT 5F
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-5018
Practice Address - Country:US
Practice Address - Phone:678-984-8683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GINNIE MAE RESIDENCE CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities