=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336235795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EASTERN CAROLINA CASE MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 08/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 154 BEACON DR SUITE I
-----------------------------------------------------
City | WINTERVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28590-7860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-353-1114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 564 VERNON WHITE RD
-----------------------------------------------------
City | WINTERVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28590-8672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-531-2902
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MRS. LESLEY DOVER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-531-2902
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------