Provider Demographics
NPI:1528198892
Name:HAMPTON HOME
Entity Type:Organization
Organization Name:HAMPTON HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAP PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-938-9373
Mailing Address - Street 1:100 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4029
Mailing Address - Country:US
Mailing Address - Phone:910-938-9373
Mailing Address - Fax:910-938-9373
Practice Address - Street 1:100 CYPRESS CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4029
Practice Address - Country:US
Practice Address - Phone:910-938-9373
Practice Address - Fax:910-938-9373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-067-073320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409009Medicaid