Provider Demographics
NPI:1861686982
Name:SAMPSON FAMILY CARE HOME
Entity Type:Organization
Organization Name:SAMPSON FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESIA
Authorized Official - Middle Name:SAMPSON
Authorized Official - Last Name:HAMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-521-8843
Mailing Address - Street 1:PO BOX 2895
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-2895
Mailing Address - Country:US
Mailing Address - Phone:910-521-8843
Mailing Address - Fax:910-521-8336
Practice Address - Street 1:101 VANCE ST.
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372
Practice Address - Country:US
Practice Address - Phone:910-521-8843
Practice Address - Fax:910-521-8336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC780-028310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility