Provider Demographics
NPI:1154867604
Name:SAMARA HOUSE
Entity type:Organization
Organization Name:SAMARA HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:NCAC
Authorized Official - Phone:610-384-9591
Mailing Address - Street 1:423 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-3411
Mailing Address - Country:US
Mailing Address - Phone:610-384-9591
Mailing Address - Fax:
Practice Address - Street 1:423 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3411
Practice Address - Country:US
Practice Address - Phone:610-384-9591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251K00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health