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General NPI Number Information
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NPI Number | 1962556696
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Entity Type | Organization
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Legal Business Name | EASTER SEALS UCP NORTH CAROLINA
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 3405 W WENDOVER AVE STE H
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City | GREENSBORO
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State | NC
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Zip | 27407-1525
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Country | US
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Telephone | 336-272-9602
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Fax |
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Provider Business Mailing Address
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Address Line | 5700 EXECUTIVE CENTER DR SUITE 110
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City | CHARLOTTE
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State | NC
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Zip | 28212-8858
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Country | US
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Telephone | 704-566-6040
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Fax | 704-971-2537
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MRS. NASHEBA YVETTE KEY-ALLRED
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Credential |
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Telephone | 919-865-8632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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