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NPI Code Detail

MEDICARE: EASTER SEALS UCP NC & VA, INC.

MEDICARE: EASTER SEALS UCP NC & VA, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063566776
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTER SEALS UCP NC & VA, INC.
Provider Business Mailing Address
First Line : 5171 GLENWOOD AVENUE
Second Line : STE 400
City : RALEIGH
State : NC
Zip : 27612
Country : US
Telephone Number : 919-783-8898
Fax Number : 919-865-8781
Provider Business Practice Location Address
First Line : 314 CHAPONOKE ROAD
Second Line :
City : RALEIGH
State : NC
Zip : 27603-3400
Country : US
Telephone Number : 919-773-2020
Fax Number : 919-773-1044
Authorized Official
Title or Position : ENROLLMENT COORDINATOR
Name : TANITA COX
Credential :
Telephone Number : 919-865-8780
Provider Enumeration Date : 01/22/2007
Last Update Date : 10/17/2014

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