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NPI Code Detail

MEDICARE: EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.

MEDICARE: EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, 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
1251B00000XCase Management Agency
2251S00000XCommunity/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 : 1396899019
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.
Provider Business Mailing Address
First Line : 5171 GLENWOOD AVE
Second Line : SUITE 400
City : RALEIGH
State : NC
Zip : 27612-3266
Country : US
Telephone Number : 919-783-8898
Fax Number :
Provider Business Practice Location Address
First Line : 10150 MALLARD CREEK RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-9708
Country : US
Telephone Number : 704-333-8220
Fax Number :
Authorized Official
Title or Position : CONTRACT ADMINISTRATOR
Name : MR. RICHARD EDWARDS
Credential :
Telephone Number : 919-783-8898
Provider Enumeration Date : 01/22/2007
Last Update Date : 12/15/2015

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