1861838492 NPI number — EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC

Table of content: (NPI 1861838492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861838492 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:
1861838492
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 WEBB BLVD
Provider Second Line Business Mailing Address:
PO BOX 629
Provider Business Mailing Address City Name:
HAVELOCK
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28532-1930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-447-3892
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10150 MALLARD CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-9708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-333-8220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2013

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 LINE
Authorized Official Telephone Number:
919-783-8898

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7200481 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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