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General NPI Number Information
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NPI Number | 1699196725
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Entity Type | Organization
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Legal Business Name | EASTERSEALS UCP NORTH CAROLINA & VIRGINIA
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 12/17/2013
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Provider Practice Location Address
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Address Line | 108 GUINEVERE LN
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City | GREENVILLE
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State | NC
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Zip | 27858-8628
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Country | US
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Telephone | 919-865-8780
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Fax |
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Provider Business Mailing Address
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Address Line | 5171 GLENWOOD AVE STE 400
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City | RALEIGH
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State | NC
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Zip | 27612-3266
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Country | US
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Telephone | 919-865-8780
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Fax |
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Authorized Official
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Title or Position | VP
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Name | RICHARD EDWARD
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Credential |
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Telephone | 919-865-8780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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