Provider Demographics
NPI:1619173366
Name:SAMARITANS NETWORK INC
Entity Type:Organization
Organization Name:SAMARITANS NETWORK INC
Other - Org Name:
Other - Org Type:
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:
Authorized Official - Phone:252-799-0300
Mailing Address - Street 1:408 N MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-1931
Mailing Address - Country:US
Mailing Address - Phone:252-789-8305
Mailing Address - Fax:252-789-8305
Practice Address - Street 1:408 N MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-1931
Practice Address - Country:US
Practice Address - Phone:252-789-8305
Practice Address - Fax:252-789-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-058-013320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804585Medicaid