Provider Demographics
NPI:1558804468
Name:SAMANTHA'S HOUSE INC.
Entity Type:Organization
Organization Name:SAMANTHA'S HOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORNELL
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-300-2134
Mailing Address - Street 1:5412 CREEK RUN CT
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-8490
Mailing Address - Country:US
Mailing Address - Phone:240-300-2134
Mailing Address - Fax:
Practice Address - Street 1:5412 CREEK RUN CT
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-8490
Practice Address - Country:US
Practice Address - Phone:240-300-2134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-24
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility