1528744067 NPI number — EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.

Table of content: (NPI 1528744067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528744067 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:
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528744067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5171 GLENWOOD AVE STE 211
Provider Second Line Business Mailing Address:
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:
919-783-8898
Provider Business Mailing Address Fax Number:
919-782-5486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 PLANTERS CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLETCHER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28732-8324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-230-0549
Provider Business Practice Location Address Fax Number:
828-658-9896
Provider Enumeration Date:
06/27/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BEAVERS
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
919-210-7661

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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