Provider Demographics
NPI:1033813621
Name:EMANUEL'S SONS AND DAUGHTERS OF PROMISE
Entity Type:Organization
Organization Name:EMANUEL'S SONS AND DAUGHTERS OF PROMISE
Other - Org Name:EMANUEL'S SONS AND DAUHGTERS OF PROMISE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-318-2176
Mailing Address - Street 1:13180 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5952
Mailing Address - Country:US
Mailing Address - Phone:910-318-2176
Mailing Address - Fax:
Practice Address - Street 1:13180 GASTON AVE
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5952
Practice Address - Country:US
Practice Address - Phone:910-318-2176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty