Provider Demographics
NPI:1497068605
Name:SAMARITAN NETWORK, INC.
Entity Type:Organization
Organization Name:SAMARITAN NETWORK, INC.
Other - Org Name:SAMARITANS NETWORK,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:252-799-0300
Mailing Address - Street 1:300 S PEARL ST
Mailing Address - Street 2:P.O.BOX 564
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-2330
Mailing Address - Country:US
Mailing Address - Phone:252-799-0300
Mailing Address - Fax:252-799-0314
Practice Address - Street 1:300 S PEARL ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2330
Practice Address - Country:US
Practice Address - Phone:252-799-0300
Practice Address - Fax:252-799-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-058-041302R00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396981676Medicaid
NC1477683928Medicaid
NC1619173366Medicaid