Provider Demographics
NPI:1235166505
Name:SAMPSON COUNTY DEPARTMENT OF AGING
Entity Type:Organization
Organization Name:SAMPSON COUNTY DEPARTMENT OF AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:BULLARD
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-592-4653
Mailing Address - Street 1:371 ROWAN RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-4727
Mailing Address - Country:US
Mailing Address - Phone:910-592-4653
Mailing Address - Fax:910-590-2142
Practice Address - Street 1:371 ROWAN RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-4727
Practice Address - Country:US
Practice Address - Phone:910-592-4653
Practice Address - Fax:910-590-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0784251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408426Medicaid
NC6600038Medicaid