1619302312 NPI number — EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.

Table of content: TAYLOR ANNE KELSO BSN, RN (NPI 1154945566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619302312 NPI number — EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1619302312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5171 GLENWOOD AVE
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27612-3266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3817 CHEEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27704-4901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-783-8898
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
VP SERVICE LINES
Authorized Official Telephone Number:
919-783-8898

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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