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General NPI Number Information
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NPI Number | 1366586331
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Entity Type | Organization
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Legal Business Name | SAMPSON'S FAMILY SUPPORT, LLC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16 STANLEY RD
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City | PEMBROKE
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State | NC
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Zip | 28372-8540
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Country | US
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Telephone | 910-521-9553
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Fax |
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Provider Business Mailing Address
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Address Line | 16 STANLEY RD
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City | PEMBROKE
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State | NC
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Zip | 28372-8540
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHEREE L SAMPSON
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Credential |
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Telephone | 910-827-1169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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