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General NPI Number Information
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NPI Number | 1770335382
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Entity Type | Organization
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Legal Business Name | EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.
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Dates
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Enumeration Date | 04/05/2024
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 4300 SAPPHIRE CT STE 110
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City | GREENVILLE
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State | NC
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Zip | 27834-9079
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Country | US
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Telephone | 252-830-7540
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Fax |
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Provider Business Mailing Address
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Address Line | 5171 GLENWOOD AVE STE 211
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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 | 919-783-8898
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | BRETT TURNER BEAVERS
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Credential |
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Telephone | 919-210-7661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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