Provider Demographics
NPI:1659797405
Name:SAMARITAN HOME
Entity Type:Organization
Organization Name:SAMARITAN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:859-619-1095
Mailing Address - Street 1:160 MOORE DR
Mailing Address - Street 2:STE. 207
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2932
Mailing Address - Country:US
Mailing Address - Phone:859-806-0247
Mailing Address - Fax:
Practice Address - Street 1:95 GOODWATER ST
Practice Address - Street 2:
Practice Address - City:JENKINS
Practice Address - State:KY
Practice Address - Zip Code:41537-9749
Practice Address - Country:US
Practice Address - Phone:859-285-9662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY=========Medicaid