1497809123 NPI number — EASTER SEALS UCP 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 1497809123 NPI number — EASTER SEALS UCP NORTH CAROLINA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTER SEALS UCP 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:
1497809123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 EXECUTIVE CENTER DR
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28212-8858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-566-6040
Provider Business Mailing Address Fax Number:
704-971-2537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2315 MYRON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-3344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-566-6040
Provider Business Practice Location Address Fax Number:
704-971-2537
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TWEED
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
704-566-6040

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)

  • Identifier: 8300507B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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