Provider Demographics
NPI:1598960890
Name:DUPLIN SAMPSON GROUP HOMES, INC.
Entity Type:Organization
Organization Name:DUPLIN SAMPSON GROUP HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARONDA
Authorized Official - Middle Name:STEFFEN
Authorized Official - Last Name:STEFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-592-8395
Mailing Address - Street 1:826 SOUTHEAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-4322
Mailing Address - Country:US
Mailing Address - Phone:910-592-8395
Mailing Address - Fax:910-596-0005
Practice Address - Street 1:716 CURTIS RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NC
Practice Address - Zip Code:28398-2204
Practice Address - Country:US
Practice Address - Phone:910-592-8395
Practice Address - Fax:910-596-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-031-039315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC780 4620OtherPROVIDER