MEDICARE: SAMARITANS NETWORK INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	MHL-058-013	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619173366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITANS NETWORK INC

Provider Business Mailing Address
First Line	:	408 N MARTIN LUTHER KING JR DR
Second Line	:
City	:	WILLIAMSTON
State	:	NC
Zip	:	27892-1931
Country	:	US
Telephone Number	:	252-789-8305
Fax Number	:	252-789-8305

Provider Business Practice Location Address
First Line	:	408 N MARTIN LUTHER KING JR DR
Second Line	:
City	:	WILLIAMSTON
State	:	NC
Zip	:	27892-1931
Country	:	US
Telephone Number	:	252-789-8305
Fax Number	:	252-789-8305

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. MARIAN BROWN CANNON
Credential	:
Telephone Number	:	252-799-0300

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	08/22/2020

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Directions to “SAMARITANS NETWORK INC ” Practice Location

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