Provider Demographics
NPI:1306202155
Name:SAMARA'S VILLAGE, INC
Entity Type:Organization
Organization Name:SAMARA'S VILLAGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-294-0292
Mailing Address - Street 1:5098 CAPSTAN CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-2203
Mailing Address - Country:US
Mailing Address - Phone:910-294-0292
Mailing Address - Fax:
Practice Address - Street 1:5098 CAPSTAN CT
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-2203
Practice Address - Country:US
Practice Address - Phone:910-294-0292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-10
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable