1932414489 NPI number — EASTER SEALS UCP OF NORTH CAROLINA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932414489 NPI number — EASTER SEALS UCP OF NORTH CAROLINA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTER SEALS UCP OF NORTH CAROLINA
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:
1932414489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2010
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:
SUITE 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:
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:
737 KNOLLWOOD DR
Provider Second Line Business Practice Location Address:
F
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28791-3479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-697-6378
Provider Business Practice Location Address Fax Number:
828-697-1515
Provider Enumeration Date:
08/09/2010

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 3104A0625X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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