Provider Demographics
NPI:1164212684
Name:DAVENPORT, GINGER SAMANTHA
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:SAMANTHA
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 ECHO LAKE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-2564
Mailing Address - Country:US
Mailing Address - Phone:252-377-2301
Mailing Address - Fax:252-231-1649
Practice Address - Street 1:1327 ECHO LAKE LN
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-2564
Practice Address - Country:US
Practice Address - Phone:252-377-2301
Practice Address - Fax:252-231-1649
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home