Provider Demographics
NPI:1598055691
Name:SAMO HOLDINGS, INC
Entity Type:Organization
Organization Name:SAMO HOLDINGS, INC
Other - Org Name:AMINA'S HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-729-2514
Mailing Address - Street 1:2467 CHAUNCEY LN SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4536
Mailing Address - Country:US
Mailing Address - Phone:404-729-2514
Mailing Address - Fax:678-264-5461
Practice Address - Street 1:5530 SWANSON RD
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-3857
Practice Address - Country:US
Practice Address - Phone:404-729-2514
Practice Address - Fax:678-264-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031013109320800000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities