Organization
SAMANTHA'S HOUSE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORNELL DEWAYNE THOMAS (CEO/PRESIDENT)
(240) 300-2134
Entity
Organization
Contact information
Practice address
5412 CREEK RUN CT, KINGS MOUNTAIN, NC 28086-8490
(240) 300-2134
Mailing address
5412 CREEK RUN CT, KINGS MOUNTAIN, NC 28086-8490
(240) 300-2134
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
11/24/2016
Last updated
11/24/2016
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