Provider Demographics
NPI:1841424256
Name:SAMARITAN NETWORK, INC
Entity Type:Organization
Organization Name:SAMARITAN NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:252-799-0300
Mailing Address - Street 1:300 S PEARL ST
Mailing Address - Street 2:P.O. BOX 564
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-2330
Mailing Address - Country:US
Mailing Address - Phone:252-799-0300
Mailing Address - Fax:252-799-0314
Practice Address - Street 1:300 S PEARL ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2330
Practice Address - Country:US
Practice Address - Phone:252-799-0300
Practice Address - Fax:252-799-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804585Medicaid
NC8301348Medicaid