Provider Demographics
NPI:1396981676
Name:SAMARITANS NETWORK, INC
Entity type:Organization
Organization Name:SAMARITANS NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1:408 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:252-799-0300
Mailing Address - Fax:252-799-0314
Practice Address - Street 1:408 N MARTIN LUTHER KING JR DR
Practice Address - Street 2:202 SOUTH HARRELL STREET
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-1931
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:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
NCMHL-058-013320900000X
NCMHL-058-032320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301348Medicaid
NC7804585Medicaid